Prognostic significance and immune landscape of a cell cycle progression-related risk model in bladder cancer

BACKGROUND

A greater emphasis has been placed on the part of cell cycle progression (CCP) in cancer in recent years. Nevertheless, the precise connection between CCP-related genes and bladder cancer (BCa) has remained elusive. This study endeavors to establish and validate a reliable risk model incorporating CCP-related factors, aiming to predict both the prognosis and immune landscape of BCa.

METHODS

Clinical information and RNA sequencing data were collected from the GEO and TCGA databases. Univariate and multivariate Cox regression analyses were conducted to construct a risk model associated with CCP. The performance of the model was assessed using ROC and Kaplan-Meier survival analyses. Functional enrichment analysis was employed to investigate potential cellular functions and signaling pathways. The immune landscape was characterized using CIBERSORT algorithms. Integration of the risk model with various clinical variables led to the development of a nomogram.

RESULTS

To build the risk model, three CCP-related genes (RAD54B, KPNA2, and TPM1) were carefully chosen. ROC and Kaplan-Meier survival analysis confirm that our model has good performance. About immunological infiltration, the high-risk group showed decreased levels of regulatory T cells and dendritic cells coupled with increased levels of activated CD4 + memory T cells, M2 macrophages, and neutrophils. Furthermore, the nomogram showed impressive predictive power for OS at 1, 3, and 5 years.

CONCLUSION

This study provides new insights into the association between the CCP-related risk model and the prognosis of BCa, as well as its impact on the immune landscape.

Spontaneous tumour lysis secondary to gastric adenocarcinoma

We present a case of a man in his 70s who presented with worsening rectal and back pain associated with weight loss, dyspnoea and brownish discolouration of urine. Physical examination noted abdominal distention and epigastric tenderness. Laboratory investigations revealed acute kidney injury, hyperkalaemia, hyperphosphataemia and hyperuricaemia. Contrast CT of the abdomen/pelvis showed multiple, low-density masses throughout the liver, suspicious for metastatic disease. Oesophagogastroduodenoscopy demonstrated a large, fungating, infiltrative and ulcerated mass in the gastric body and lesser curvature of the stomach. Surgical pathology confirmed invasive moderately differentiated gastric adenocarcinoma. He met both the laboratory and clinical criteria for spontaneous tumour lysis syndrome (STLS) as per the Cairo-Bishop criteria. He was managed with aggressive fluid hydration, rasburicase and allopurinol, resulting in improvement in his renal function and laboratory findings. STLS of solid organ tumours, especially gastric adenocarcinoma, is rare and requires early detection with timely management to ensure favourable outcomes.

Human papillomavirus related oropharyngeal cancer: identifying and quantifying topics of patient interest

OBJECTIVE

As the incidence of human papillomavirus related oropharyngeal cancer continues to rise, it is increasingly important for public understanding to keep pace. This study aimed to identify areas of patient interest and concern regarding human papillomavirus and oropharyngeal cancer.

METHOD

This study was a retrospective survey of search queries containing the keywords 'HPV cancer' between September 2015 and March 2021.

RESULTS

There was 3.5-fold more interest in human papillomavirus related oropharyngeal cancer (15 800 searches per month) compared with human papillomavirus related cervical cancer (4500 searches per month). Among searches referencing cancer appearance, 96.8 per cent pertained to the head and neck region (3050 searches per month). Among vaccination searches, 16 of 47 (34.0 per cent; 600 searches per month) referenced human papillomavirus vaccines as being a cause of cancer rather than preventing cancer.

CONCLUSION

The vast majority of online searches into human papillomavirus cancer pertain to the oropharynx. There are relatively few search queries on the topic of vaccination preventing human papillomavirus associated oropharyngeal cancer, which highlights the continued importance of patient education and awareness campaigns.

Hippocampus Segmentation-Based Alzheimer's Disease Diagnosis and Classification of MRI Images

Alzheimer's disease represents a neurological condition characterized by steady cognitive decline and eventual memory loss due to the death of brain cells. It is one of the most prominent dementia types observed in patients and which hence underlines the imminent need for potential methods to diagnose the disease early on. This work considers a novel approach by utilizing a reduced version of one of the datasets used in this work to achieve a considerably accurate prediction while also enabling quicker training. It leverages image segmentation to isolate the hippocampus region from brain MRI images and then strikes a comparison between models trained on the segmented portions and models trained on complete images. This research uses two datasets-4 classes of images from Kaggle and a popular OASIS 2 MRI and demographic dataset. A deep learning-based approach was adopted to train the Kaggle dataset to perform severity classification, and the hippocampus region segmented from a reduced version of the OASIS dataset was trained on supervised and ensemble learning algorithms to detect Alzheimer's disease. The metric used for the assessment of model performance is classification accuracy. A comparative analysis between the proposed approach and existing work was also performed, and it was observed that the proposed approach is effective in the early diagnosis of Alzheimer's disease.

Attributable Mortality and Excess Length of Stay associated with Third-Generation Cephalosporin Resistant Enterobacterales Bloodstream Infections - a prospective cohort study in Suva, Fiji

OBJECTIVES

There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the impact of third-generation cephalosporin resistance (3GC-R) on mortality and excess length of hospital stay in Fiji.

METHODS

We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional hazards models to estimate the effect of 3GC-R on the daily risk (hazard) of in-hospital mortality and being discharged alive (competing risks), and multistate modelling to estimate the excess length of hospital stay.

RESULTS

From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs, 3GC-R was present in 66 (40.7%). Crude mortality for patients with 3GC-susceptible and 3GC-R BSIs was 16.7% (16/96) and 30.3% (20/66), respectively. 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio (aHR) 1.13, 95% CI 0.51-2.53) or being discharged alive (aHR 0.99, 95% CI 0.65-1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36-1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31-9.71) were both associated with an increased hazard rate of in-hospital mortality. 3GC-R was associated with an increased length of stay of 2.6 days (95% CI 2.5-2.8). 3GC-R was more common among hospital-associated infections, but genomics did not identify clonal transmission.

CONCLUSION

Patients with Enterobacterales BSIs in Fiji had high mortality. There were high rates of 3GC-R, which was associated with increased hospital length of stay but not with in-hospital mortality.

LBX2 expression and outcomes in patients with colon adenocarcinoma

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Background: Colon adenocarcinoma (COAD) is one of the most common gastrointestinal cancers worldwide. Previous studies found that Ladybird homeobox 1 (LBX1) and Ladybird homeobox 2 (LBX2), were involved in the progress of several types of cancer. However, studies on their roles in cancers, such as COAD, are very limited. Thus, this study was performed to explore their roles in COAD. Methods: RNA-sequencing FPKM data and corresponding clinical information of 480 tumor tissues of COAD and 41 normal tissues were obtained from The Cancer Genome Atlas (TCGA). The ‘limma’ package was used to compare the expression differences of LBX1 and LBX2 between the normal and cancer tissues using Wilcoxon rank-sum test. Analysis of overall survival (OS), disease specific survival (DSS), and progression free interval (PFI) were conducted by Kaplan–Meier (K–M) method via ‘survminer’ package. Univariate Cox hazard regression analysis of OS was applied to five clinicopathological variables from T stage, N stage, M stage, pathologic stage, CEA level, as well as the expression level of family members of LBX that are overexpressed and associated with worsening survival outcomes, by using ‘survival’ package. Furthermore, a nomogram was also visualized by the R ‘rms’ package and ‘survival’ package to predict the 1-, 3-, and 5-year OS and individual predictors. Results: The expression of LBX2 (p = 8.1e-20) was upregulated in COAD tissues compared with normal tissues, while no statistically significant difference of expression between normal tissues and tumor was found for LBX1 (p = 0.06). Further survival analysis found that higher expression of LBX2 was associate with worse OS (HR = 2.45, 95%CI 1.62-3.71, p < 0.001), DSS (HR = 2.34, 95%CI 1.39-3.96, p = 0.001), and PFI (HR = 1.48, 95%CI 1.04-2.10, p = 0.03). Univariate Cox hazard regression analysis showed that N1, N2, N3, M1, pathologic stage III and IV, CEA level&gt;5, and high expression level of LBX2 were associated with worse OS (all p < 0.05). The nomogram based on six clinicopathological variables (T stage, N stage, M stage, pathologic stage, CEA level, and LBX2 expression level) and 1-, 3-, 5-year OS probabilities were developed, with concordance index (C-index) of 0.795(0.755-0.834), indicating its prediction value and sufficient discrimination ability, as C-index was more than 0.7. The calibration curves of 1-, 3-, and 5-year demonstrated the consistency of our results and the predictive values, indicating satisfactory performance for this nomogram. Moreover1-, 3-, 5-year AUCs of LBX2-based nomogram were 0.805, 0.831, and 0.774, showing a moderate accuracy. Conclusions: LBX2 are upregulated in COAD tumor samples, and its higher expression is associated with worsening OS, DSS, and PFI. The LBX2-based monogram developed by this study might help predict the OS possibilities for COAD patients. LBX2 can be a potential diagnostic and prognostic marker, and therapeutic marker in COAD.

Association of ITGA 11 and ITGAV upregulation with outcomes in gastric cancer

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Background: Gastric cancer (GC) is a common cancer worldwide. The integrin α (ITGA) family members play essential roles in various cancers and variants of ITGA are involved in metastatic process in gastric cancer. Thus, this study was conducted to explore the roles of ITGA family members in stomach adenocarcinoma (STAD). Methods: RNA-sequencing FPKM data and corresponding clinical information of 375 STAD tumor tissues and 32 normal tissues were retrieved from The Cancer Genome Atlas (TCGA). The ‘limma’ package was used to compare the expression differences between the normal and cancer tissues using Wilcoxon rank-sum test. Analysis of overall survival (OS) was conducted by Kaplan–Meier (K–M) method via ‘survminer’ package. Univariate Cox hazard regression analysis was applied to seven clinicopathological variables from T stage, N stage, M stage, pathologic stage, histologic grade, gender, age, and expression level of selected ITGA family members, by using ‘survival’ package. Furthermore, a nomogram was also visualized by the R ‘rms’ package and ‘survival’ package to predict the 1-, 3-, and 5-year OS and individual predictors. Results: The expression of ITGA2, ITGA3, ITGA4, ITGA5, ITGA6, ITGA11, and ITGAV were upregulated in STAD tissues compared with normal tissues (P<0.05), whereas ITGA7, ITGA8, and ITGA9 were downregulated in tumor tissues (P<0.05). In addition, no statistically significant difference was found for TGA1 and ITGA10 between tumor and normal tissues ((P>0.05). Further survival analysis found that higher expression of ITGA 11 (HR=1.46, 95%CI 1.05-2.03, P<0.026) and ITGAV (HR=1.92, 95%CI 1.37-2.70, P<0.001) were associate with worse OS. Univariate Cox hazard regression analysis showed that T3, T4, N1, N3, M1, pathologic stage III and IV, age>65, and high expression level of ITGA11 and ITGAV were associated with worse OS (all P < 0.05). The nomogram based on six clinicopathological variables (T stage, N stage, M stage, pathologic stage, age, and expression levels of ITGA11 and ITGAV) and 1-, 3-, 5-year OS probabilities were developed. The concordance index (C-index) of the nomograms was 0.673(0.647-0.700), indicating that the potential predicting role and sufficient discrimination ability of the nomogram as C-index was more than 0.5. The calibration curves of 1-, 3-, and 5-year indicated the consistency of our results and the predictive values, indicating satisfactory performance for this nomogram. However, 1-, 3-, 5-year AUCs of ITGA11- and ITGAV-based nomogram were 0.687, 0.691, and 0.687, showing a relatively acceptable accuracy as they were great than 0.5. Conclusions: ITGA2, ITGA3, ITGA4, ITGA5, ITGA6, ITGA11, and ITGAV are upregulated, while ITGA7, ITGA8, and ITGA9 are down regulated in STAD tumor samples. High expression levels of ITGA11 and ITGAV are associated with worse OS. The ITGA11- and ITGAV-based monogram developed by this study might be useful in predicting the OS outcome for STAD patients.

CLK2 upregulation and outcomes for males with colorectal adenocarcinoma

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Background: Colorectal adenocarcinoma (COAD) is a common cancer in gastrointestinal tract. CDC-like kinase (CLK) family, containing four characterized isoforms (CLK1-4), have been reported for their roles in precursor-mRNA splicing. However, studies on their roles in COAD are limited. Thus, this study was performed to explore the roles of CLK family members in COAD. Methods: RNA-sequencing FPKM data and corresponding clinical information of 41 normal tissues and 480 tumor tissues of COAD were obtained from The Cancer Genome Atlas (TCGA). Then expression differences of CLK family between the normal tissues and COAD cancer tissues were compared with Wilcoxon rank-sum test via ‘limma’ package. Overall survival (OS) of upregulated CLK family members was analyzed by Kaplan–Meier (K–M) method via ‘survminer’ package. Subgroup analyses of different genders were also conducted. The best discriminate cut-off point between the high and low expression groups was assessed by the receiver operating characteristic (ROC) curve and area under the curve (AUC) values for upregulated CLK family members via ‘pROC’ package to assess their diagnostic values. Results: The expression of CLK1 and CLK2 were upregulated in tumors compared with normal tissues (p < 0.001), while CLK3 were downregulated in tumor tissues (p = 0.02) and no statically significant difference was found regarding CLK4 (p = 0.25). Higher expression of CLK1 was not associated with a change of OS (HR: 1.24, 95%CI: 0.84-1.83, p = 0.279), while higher expression of CLK2 is associated with worse OS (HR: 2.03, 95%CI: 1.34-3.06, p = 0.001). Subgroup analysis found that higher expression of CLK2 was associated with worse OS (HR: 2.28, 95%CI 1.27-4.08, p = 0.006) in males, but not in females (HR: 1.72, 95%CI 0.95-3.10, P = 0.072). Further analysis of ROC curve shown that AUC of CLK1 and CLK2 were 0.748 (0.687-0.809) and 0.884 (0.840-0.928), respectively. Conclusions: CLK1 and CLK2 are upregulated in COAD tumor samples, and higher expression of CLK2 in male COAD patients is associated worse OS. This demonstrated the potential therapeutic value of CLK2 in male patients with COAD. ROC curve indicated the potential diagnostic value of CLK1 and CLK2.

ENDOV upregulation and outcomes in females with colorectal adenocarcinoma

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Background: Colorectal adenocarcinoma (COAD) is a common cancer in gastrointestinal tract. Endonuclease V (ENDOV), an enzyme with specificity for deaminated adenosine (inosine) in nucleic acids, was found to be involved in the development of certain cancers. Thus, this study was performed to explore the effects of ENDOV on the prognosis of COAD. Methods: RNA-sequencing FPKM data and corresponding clinical information of 41 normal tissues and 480 tumor tissues of COAD were acquired from The Cancer Genome Atlas (TCGA). Then ENDOV expression differences between the normal and cancer tissues were compared with Wilcoxon rank-sum test via ‘limma’ package. Overall survival (OS) and disease specific survival (DSS) analyses were conducted by Kaplan–Meier (K–M) method via ‘survminer’ package. Subgroup analyses of different genders were also performed. Results: The expression of ENDOV was downregulated in tumors compared with normal tissues (p < 0.001). However, higher expression of ENDOV is associated with worse OS (HR: 1.83, 95%CI: 1.23-2.73, P = 0.003) and DSS (HR: 1.75, 95%CI 1.06-2.91, P = 0.03). Subgroup analysis found that higher expression of ENDOV was associated with worse OS (HR: 2.17, 95%CI 1.18-3.98, P = 0.012) in females, but not in males (HR: 1.48, 95%CI 0.86-2.53, P = 0.158). As for DSS, higher expression of ENDOV was also correlated with worse outcome (HR: 2.36, 95%CI 1.07-5.19, P = 0.033) in females, but not in males (HR: 1.45, 95%CI 0.73-2.86, P = 0.287). Conclusions: ENDOV is overall downregulated in COAD tumor samples. However, higher expression of ENDOV in certain COAD patients is associated worse OS and DSS in females but not in males. This indicates the potential role of ENDOV in predicating the prognosis of COAD in female patients.

Amelioration of fly annoyance in dairy cattle by using illuminated fly traps

Blood-sucking and biting flies are a significant source of annoyance to warm-blooded animals. Behavioural changes in animals may include attempts to pursue, remove or avoid the disturbance caused by the fly by means of body movement. In the presesnt study the behaviour during a 10 min period in each four-hour interval i.e. 1 AM, 5 AM, 9 AM, 1 PM, 5 PM and 9 PM was analysed and noted for inclusion in the ethogram. The cows with light trap (treatment) were compared with those without light traps (control) to study the effectivenss of the fly trap in reducing annoyance in cattle. All the seven avaoidance behaviours were counted such as head movement, ear shaking, tail movement, skin twitching, licking, kicking on belly and restlessness and were recorded by scan method. The results of this study indicated that the incidence of all the seven fly avoidance behaviours were significantly higher (p<0.01) in the control group. It could also be concluded that the occurance of all the behaviours in the control group at 1 PM were significantly high followed by 5 PM. The findings of the study suggest that fly activity in dairy farms was high during the afternoon hours followed by evening time and illuminated fly traps could be used effectively in controlling flies, so that the fly avoidance behavior by cattle was reduced on dairy farms.

Seroprevalence to common infectious abortifacient and infertility causing agents in the dairy herds of India

BACKGROUND

Information on the prevalence of infectious agents in dairy farms forms the basis for formulating a suitable control strategy; especially in endemic situations.

AIMS

A cross-sectional study was undertaken to determine the prevalence of six economically important bovine diseases, causing reproductive disorders including bovine abortion in organized dairy herds in India.

METHODS

A total of 1,075 animals (cattle and buffaloes) from 09 dairy farms were screened by ELISA tests.

RESULTS

Bovine viral diarrhoea (BVD) was the most prevalent (56.5%) disease followed by infectious bovine rhinotracheitis (IBR) (45.4%). Prevalence of Q-fever (5.4%) and neosporosis (6.1%) were less on the farms. Although 16.3% of the samples turned positive for brucellosis, the contribution of calf-hood vaccination (B. abortus S19 vaccine) to the prevalence of antibodies cannot be ruled out. The overall prevalence of bovine anaplasmosis, known to cause sporadic abortions in dairy herds, was 34.1% in the 9 farms with a prevalence of less than 20% in 5 farms. Infection of multiple abortifacient (seroprevalence to more than two pathogens) was recorded in 56.8% of animals. A very strong association was observed between BVD and brucellosis (Odds ratio 14.2; P<0.001). Further, a positive association was also seen between seroprevalence of IBR and anaplasmosis, and neosporosis and Q fever (P<0.05).

CONCLUSION

Viral diseases were found to be more common in the dairy herds than bacterial and protozoan diseases. Increased susceptibility of IBR seropositive cows to other bacterial and viral infections was observed.

Effectiveness of livestock delivery services of dairy cooperatives of Kerala state

The present study aimed to know the effectiveness of livestock services delivered by the veterinarians working under state regional cooperative milk producers’ union (SRCMPU) and farmers views on these services. An ex-post-facto research design was adopted for the study. A total of fifteen veterinarians working under SRCMPU, Kerala, and thirty livestock farmers dependent on SRCMPU for the livestock services were selected. Data collection was done through using structured interview schedule method. The result from the study revealed that majority of the veterinarians and livestock farmers perceived curative services (60.00% and 46.66%), production services (53.33% and 63.33%), preventive services (53.34% and 56.66%), extension services (60.00% and 50.00%) and miscellaneous services (60.00% and 60.00%) as average. About satisfaction level, majority of the livestock farmers had medium level of satisfaction towards curative services (66.66%), production services (43.33%), preventive services (60.00%), extension services (50.00%) and miscellaneous services (60.00%). It is concluded from the result that there is need to improve the quality of livestock services from both veterinarians and farmers point of view. It is the need of hour to analyze and interpret the current scenario of service delivery systems of state regional cooperative milk producers’ union through assessing the constraints perceived by them in livestock service delivery.

Rare case of metastatic adenocarcinoma to the maxillary sinus

Colorectal carcinoma metastases to the head and neck are exceedingly rare. Patients may present with vague symptoms that may lead to a delay in diagnosis. We report the case of a 51-year-old man with a known history of stage IIIB colorectal adenocarcinoma who presented with right-sided molar tooth bleeding and right-sided palate swelling that led to difficulty speaking, eating and weight-loss of 15 pounds. Imaging studies revealed a 3.1×4.8×3 cm mass that was centred around the posterior aspect of the maxilla. Pathology revealed moderately differentiated intestinal type adenocarcinoma of colonic subtype, immune histochemistry was positive for CDX2, CK20 and MUC2, thus confirming metastatic disease to the maxilla. The patient is undergoing chemoradiation therapy for palliation of his symptoms. Clinicians should be aware of this potentional site of metastatic disease and suspect the diagnosis in a timely manner to avoid delays in making a diagnosis.

Efficacy of targeted therapy in alveolar soft part sarcoma: A systematic review and meta-analysis

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Background: Alveolar soft part sarcoma (ASPS) is a rare subtype of soft tissue sarcoma, characterized by a specific unbalanced translocation leading to the fusion of the TFE3 gene on chromosome-X to the ASPSCR1 gene on chromosome-17. Despite its indolent course, ASPS presents a challenge in treatment due to its resistance to conventional anthracycline-based chemotherapy and lack of large scale trial data for this rare sarcoma. This review aimed to assess the efficacy of tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) in metastatic alveolar soft part sarcoma. Methods: A systematic search was performed on Embase and Medline databases for studies that assessed best response of patients with unresectable or metastatic ASPS to TKI and ICI therapy, according to the Response Evaluation Criteria in Solid Tumors (RECIST) edition 1.0 or 1.1. This study followed the Preferred Reporting Items for Systematic Reviews (PRISMA) protocol. Four independent reviewers screened abstracts and extracted the data; any discrepancy was resolved by discussion among reviewers. Pooled objective response rate (ORR) and disease control rate (DCR) were obtained using the Freeman-Tukey double-arcsine transformation using random effects model on STATA software (version. 16.1, StataCorp). Results: 27 articles and abstracts published between 2011 and 2020 were included in the review, resulting in 2 randomized clinical trials (104 participants), 14 single arm prospective trials (214 participants), and 11 retrospective studies (120 patients). Among clinical trials, the pooled ORR and DCR were 18% (95% confidence interval [CI] 8 - 30%; I2 = 72.25%; p < 0.01) and 87% (95% CI 97 - 93%; I2 = 43.2%; p = 0.03) respectively. Conclusions: The response rate to targeted therapy in metastatic ASPS is not only clinically meaningful, but also comparable to that of first-line chemotherapy. The majority of patients receiving targeted therapy achieved disease control. Patients who had refractory or progressive disease to one targeted agent demonstrated response to other agents. More randomized trials are warranted to expand treatment options and compare to standard of care regimens.

458 Patient Willingness to Undergo Elective Orthopaedic Surgery in Relation to the COVID-19 Outbreak

Objective

To determine patients’ willingness to undergo elective orthopaedic surgery during the COVID-19 pandemic.

Method

4 groups of patients were chosen based on type of surgery. A telephone survey was conducted, including questions on diagnosis, symptom duration, pain severity, co-morbidities, anxiety levels for COVID-19 and surgery. Patients were given the conditions for surgery and asked whether they would undergo surgery, have the operation carried out by another consultant and any factors that would increase their confidence.

Results

Of 200 patients, 156 participated (78%). 78.2% were willing to undergo surgery. There was a statistically significant difference in willingness between age groups 40-49 (100%) and 80 + (58.3%). Differences in willingness between surgery types, BOA risk class, sex, symptom duration and pain scores, were not statistically significant.

Patients unwilling to undergo surgery reported statistically higher anxiety scores for health (4.39) and surgery (4.62) compared to the willing group (2.89 and 2.71 respectively). Patients’ main concern was contracting COVID (35.2%).

Conclusions

Our study demonstrated that the majority of patients were willing to undergo surgery. This can be used to inform strategies for resuming elective surgeries. It has also highlighted several areas in patient perception that warrant further investigation and the importance of enhanced consent on the specific risks.

Alpelisib Induced Hyperglycemic Ketoacidosis; Broadening the Adverse Effect Profile of an Emerging Cancer Therapy

Introduction:

Alpelisib (PIQRAY) is a Phosphatidylinositol 3-Kinase Inhibitor (PIP-3K) recently approved by the united states food and drug administration (FDA) for hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-mutated, advanced, or metastatic breast cancer in post-menopausal women or men with an adjuvant to Fulvestrant. Hyperglycemia is a well-known side effect of Alpelisib. However, hyperglycemic ketoacidosis is a rare and life-threatening side effect.

Case Presentation:

A 63-year-old Caucasian woman with ER/PR+, HER2- metastatic breast cancer presented to the emergency room (ER) with polydipsia, polyuria, dryness of the mouth and skin, along with a 12-pound weight loss over a period of three weeks. Alpelisib was initiated three months prior to her presentation with Hba1c: 6.4% and random BG: 89 mg/dl at the time. Her initial lab work in the ER revealed blood glucose of 474 mg/dl, sodium 129 mmol/L, potassium 5.1 mmol/L, and an anion gap of 15 with a Co2 of 19 mmol/L, HCO3 of 20 mmol/L, and a blood ketones level of 2.6. Her urinalysis revealed glucosuria and ketonuria. She was admitted to the general medical floor and Alpelisib was held. In light of her insulin naivety and no history of diabetes mellitus, it was decided to treat her with subcutaneous insulin with hourly titration based on monitoring of serum glucose and electrolytes with IV hydration. She required a total of 31 units of regular insulin along with 15 units of long-acting insulin. Her ketosis resolved within 12 hours of admission. Endocrinology was consulted and she was discharged on long-acting insulin 15. On follow-up, Alpelisib was resumed, metformin added along with long-acting insulin. Despite anti-diabetic therapy, due to persistent hyperglycemia (fasting blood glucose &gt;300 mg/dl), Alpelisib was discontinued 3 weeks after presentation.

Conclusion:

Alpelisib-induced hyperglycemic ketoacidosis is an uncommonly reported adverse event with only 3 reported cases to the best of our knowledge. While there are guidelines available to manage Alpelisib induced hyperglycemia, there are no specific recommendations for patients presenting with hyperglycemia and ketoacidosis in terms of admission to intensive care unit (ICU) or general medical floor (GMF), use of the type, route, and dosage of insulin and continuation of insulin for the persistent elevation of FBG despite interruption of Alpelisib. Alternative approaches for the treatment of breast cancer should be considered with continual hyperglycemia despite appropriate management. Multidisciplinary discussion involving the oncologist as well as an endocrinologist can be useful for the management of persistent elevation of FPG even after substantial Alpelisib free days.

The Mystery of Acidosis

We present a case of 30-year-old female with past medical history of Type 2 DM, Thyroid nodule and asymptomatic cholelithiasis who presented to ED with abdominal pain, vomiting and sinus tachycardia of 120’s for past one day. She had generalized abdominal pain, not relieved by pain killers. Her lab test includes normal blood count, glucose 150mg/dl, anion gap of 20, metabolic acidosis. Her ultrasound abdomen showed cholelithiasis with no biliary sludge formation. Given her acidosis and severe abdominal pain she was started on Zosyn and underwent cholecystectomy. Her abdominal pain and sinus tachycardia did not resolve till day 3 of admission. Urine was positive for ketones. On chart review, it was found that she started taking sodium glucose transporter 2 inhibitor (SGLT-2 inhibitor), Canagliflozin. She was given IV fluids and insulin. She improved and her tachycardia resolved. Euglycemic acidosis is a rare phenomenon but frequently misdiagnosed. This case emphasizes on importance of side effects of oral glucose lowering agents. SGLT-2 inhibitors can cause lipolysis and ketosis while maintaining euglycemia. Prompt clinical judgement is needed to prevent misdiagnosis. Also, patients should be educated about aggravating factors like stress, dehydration or other severe illnesses.

Multiple anthelmintic resistance in gastrointestinal nematodes of Caprines on Mountain Research Centre for Sheep and Goat at Kashmir Valley, India

The study was conducted to evaluate the status of anthelmintic resistance in Gastro-Intestinal Nematodes (GINs) of goats at an organized farm located in Kashmir, as there is no report of resistance against these parasites of goats from this temperate region, although it has been reported worldwide including India. Caprines reared at this farm exhibited reduced efficacy to multiple anthelmintics following treatments with Fenbendazole (FBZ), Closantel and Ivermectin (IVM) in Faecal Egg Count Reduction Test (FECRT). The results suggested that the overall efficacy was highest for IVM at 83.5% and 90.0% on 7^th and 14^th day post-treatment, respectively and least for FBZ at 44.3% and 62.5%, respectively, whereas the corresponding figures for closantel were 68.3% and 86.2%, respectively. The pre-treatment faecal culture revealed Haemonchus contortus, Teladorsagia circumcincta and Trichostrongylus colubriformis as predominant strongyles, however, in post-treatment samples, only H. contortus was observed. Further, the infective larvae were subjected to Allele specific PCR (AS-PCR) for accurate diagnosis of BZ resistance. The AS-PCR revealed 52% of H. contortus were homozygous resistant (rr) and 17% were heterozygous (rS) on day “0” before treatment and 100% homozygous resistant (rr) on 7th day post treatment. In both T. colubriformis and T. circumcincta, 100% population was homozygous susceptible (SS) at day “0” before treatment. The overall frequency of resistant (r) allele for H. contortus was 60.5% and for susceptible allele (s) was 39.5%. For T. colubriformis and T. circumcincta the frequency of susceptible allele (s) was 100%. The survey indicated that the GINs of goats on the farm have developed multiple anthelmintic resistance to FBZ, closantel and IVM and the condition is alarming in the farm. Moreover surveillance studies about status of anthelmintic resistance in other farms (Govternment as well as Private) of Kashmir valley should be carried out at large scale to develop effective and sustainable control strategies against GI Nematodes.

Significance of third trimester ultrasound in detecting congenital abnormalities of kidney and urinary tract-a prospective study

INTRODUCTION

Antenatal hydronephrosis is defined as dilatation of the renal pelvis with or without dilatation of calyces in the developing fetus. Although second trimester scan is more sensitive in detecting congenital abnormalities of kidney and urinary tract (CAKUT), it has been suggested that the third trimester scan is more predictive of postnatal outcome.

OBJECTIVES

This study aims to determine the incidence of antenatal hydronephrosis at our institution and the significance of third trimester scan in detecting CAKUT postnatally.

STUDY DESIGN

It is a prospective observational study. During the 3-year study period from June 2013 to May 2016, all cases of antenatal hydronephrosis, defined as renal pelvic diameter (RPD) ≥4 mm in the second trimester and ≥7 mm in the third trimester scan, diagnosed in the fetal medicine unit of our hospital, were included and were followed up postnatally for 6 months.

RESULTS

In the fetal medicine unit, 32,443 women were screened for anomalies, and hydronephrosis was detected in 269 cases. Incidence of antenatal hydronephrosis was observed to be 0.83% in our institution. In second trimester scan, of 80 cases with the left hydronephrosis, only 22 (27.5%) had postnatal CAKUT and of 70 cases with the right hydronephrosis, 18 (25.7%) had CAKUT. In the third trimester scan, it was observed that with RPD >10 mm, on the left side hydronephrosis, 87% had CAKUT on postnatal scan, and 85% with the right hydronephrosis had CAKUT.

CONCLUSION

Sixty percent cases of hydronephrosis detected in the second trimester scan resolve in utero. In the third trimester scan with RPD <10 mm, the possibility of postnatal CAKUT is 23%, whereas if RPD is > 10 mm, then the possibility of postnatal CAKUT is 86%.

Isolation and analysis of the molecular epidemiology and zoonotic significance of Mycobacterium tuberculosis in domestic and wildlife ruminants from three states in India

The majority of tuberculosis cases in ruminants are caused by Mycobacterium bovis (MB). However, in this study, the authors reported the isolation of Mycobacterium tuberculosis (MT) from bovine milk, nasal swabs and post-mortem tissue samples (n = 841) collected from cattle and buffaloes in the states of Telangana, Maharashtra and Gujarat in India in the period from 2010 to 2015. The isolates (n = 7) were confirmed as Mycobacterium due to their growth characteristics and colony morphology in a commercial liquid medium Mycobacterial Growth Indicator Tube (MGIT)™ employing the BD BACTEC™ MGIT™ 960 system and the Löwenstein-Jensen (LJ) medium supplemented with glycerol but not with sodium pyruvate, and BD-DIFCO™ Middlebrook 7H10 agar containing oleic albumin dextrose catalase (OADC). These isolates were initially identified as members of the M. tuberculosis complex (MTC) using a commercial nested polymerase chain reaction (PCR) kit based on the IS6110 MTC specific nucleotide sequence. The isolates were confirmed as MT using three commercial line probe assay kits, were further genotyped, and the spoligotypes identified were of East African Indian (EAI) 3_IND, EAI5, Central-Asian (CAS) 1_DELHI, U and T1 lineages. Two MT isolates from one antelope (Antilope cervipara) andone gazelle (Gazella bennettii) from Gujarat, which were identified previously, were spoligotyped during this study and identified as belonging to EAI3_IND and EAI5 lineages, respectively. The epidemiological significance and zoonotic implications of regional presence and documentation of the same or two differents poligotypes in different species within the family Bovidae as well as humans is discussed.

Systematic review of the outcome of cemented versus uncemented total hip arthroplasty following pelvic irradiation

PURPOSE

The objective of this study is to evaluate the outcomes of total hip arthroplasty (THA) in patients with radiation-related changes to the bone, and specifically whether there is a difference in outcomes between cemented and uncemented acetabular components.

METHODS

A database search was performed to identify available studies reporting adults undergoing THA who have previously had pelvic irradiation. Data were extracted and analysed with respect to the use of cemented versus uncemented acetabular components. Statistical analysis was performed using the Chi-square test for independence.

RESULTS

The all-cause revision rate was 24% in the cemented THA group (27/111), compared with 15% of uncemented THAs (22/143) (p = 0.073). Revision for acetabular aseptic loosening occurred in 16% of cases (18/111) in the cemented group and 10% (15/143) in the uncemented group (p = 0.178). Acetabular aseptic loosening was reported in 24% of cemented THAs (27/111) and 14% of uncemented THAs (20/143), which was statistically significant (p = 0.035). Not all of these went on to have revision THA. The Incidence of prosthetic joint infection was similar in both groups.

CONCLUSION

Overall outcomes appear to be better for uncemented THAs in post-radiotherapy patients, with a significantly lower rate of aseptic loosening and an appreciable (but not statistically significant) reduction in revision rate. The best outcomes seem to be associated with the use of acetabular reinforcement across both cemented and uncemented groups, but further work is needed to evaluate this.

Immune response against subclinical haemonchosis in Himalayan hill goats

Haemonchosis commonly occurs as chronic and subclinical infection in small ruminants, and understanding of immunological response against subclinical haemonchosis is of paramount importance for designing and implementing effective control strategies. The present study was designed to evaluate immunological response during subclinical haemonchosis, experimentally established in goats. Sixteen 5-6 month-old helminth naive kids were randomly allocated into one of two groups, infected and uninfected; the infected group being infected per os with 250 Haemonchus contortus larvae per kg body weight. Faecal, blood and serum samples were collected every third day up to 30 days post-infection (DPI), thereafter weekly up to 58 DPI to record changes in faecal egg count (FEC), haemoglobin (Hb), packed cell volume (PCV), peripheral eosinophil percentage and immunological parameters, such as macrophage cytokine interleukin-12 (IL-12), Th1 cytokine (IFN-γ), Th2 cytokines (IL-4, 13, 25, 33) and immunoglobulins (IgG and IgE). Pre-patent period of H. contortus in the present study was 18 days and eggs per gram (EPG) peaked on 30 DPI. The total reduction in body weight gain in the infected group was 26 g per day when compared with uninfected animals. Hb (7.35 ± 0.34 g/dL in infected animals compared with 9.76 ± 0.67 in control animals) and PCV levels (22 ± 1.54 g/dL in infected animals compared with 29.2 ± 1.27 in control animals) decreased significantly up to 44 DPI in infected group (P = 0.000). IL-4, IL-13, IL-33, IgG and IgE showed significant increase in infected animals at different periods. IFN-γ, IL-12 and IL-25 did not show any significant changes barring a steep rise of IFN-γ on 27 DPI. A positive correlation was observed between IgE and IL-4 in subclinical haemonchosis. Of particular note was that all the major cytokines, such as IFN-γ (P = 0.000), IL-4 (P = 0.000), IL-13 (P = 0.009), and both IgG (P = 0.000) and IgE (P = 0.003), were observed at the lowest concentration on 24 DPI. The effect of infection was found to be significant on cytokines with a strong interaction with time. Taken together, the data suggest that Th2 immune response is predominating in subclinical haemonchosis. The economic loss in term of body weight gain due to subclinical haemonchosis was considerable.

Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals

OBJECTIVES

We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all-cause mortality as a secondary outcome, after hospitalization for ACS among HIV-infected and HIV-uninfected individuals.

METHODS

We conducted a retrospective cohort study within Kaiser Permanente Northern California of HIV-infected and HIV-uninfected adults discharged after ACS hospitalization [types: ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina] during 1996-2010. We compared the outcomes of ACS recurrence and all-cause mortality within 3 years, both overall by HIV status and stratified by recent CD4 count, with HIV-uninfected individuals as the reference group. Hazard ratios (HRs) were obtained from Cox regression models with adjustment for age, sex, race/ethnicity, year, ACS type, smoking, and cardiovascular risk factors.

RESULTS

Among 226 HIV-infected and 86 321 HIV-uninfected individuals with ACS, HIV-infected individuals had a similar risk of ACS recurrence compared with HIV-uninfected individuals [HR 1.08; 95% confidence interval (CI) 0.76-1.54]. HIV infection was independently associated with all-cause mortality after ACS hospitalization overall (HR 2.52; 95% CI 1.81-3.52). In CD4-stratified models, post-ACS mortality was higher for HIV-infected individuals with CD4 counts of 201-499 cells/μL (HR 2.64; 95% CI 1.66-4.20) and < 200 cells/μL (HR 5.41; 95% CI 3.14-9.34), but not those with CD4 counts ≥ 500 cells/μL (HR 0.67; 95% CI 0.22-2.08), compared with HIV-uninfected individuals (P trend < 0.001).

CONCLUSIONS

HIV infection and immunodeficiency were not associated with recurrence of ACS after hospitalization. All-cause mortality was higher among HIV-infected compared with HIV-uninfected individuals, but there was no excess mortality risk among HIV-infected individuals with high CD4 counts.

Irradiation-Induced Compositional Effects on Human Bone After Extracorporeal Therapy for Bone Sarcoma

The present study investigates Raman scattering of human bone irradiated with 50 Gy single dose during therapeutic treatment of Ewing and Osteosarcoma. Bone quality was evaluated via mineral-to-matrix ratio, degree of crystallinity, change in amount of calcium, and carbonate substitution. Alteration in collagen and its cross-links was quantified through second-derivative deconvolution of Amide I peak. A dose of 50 Gy radiation leads to almost 50% loss of mineral content, while maintaining mineral crystallinity, and small changes in carbonate substitution. Deconvolution of Amide I suggested modifications in collagen structure via increase in amount of enzymatic trivalent cross-linking (p < 0.05). Overall irradiation led to detrimental effect on bone quality via changes in its composition, consequently reducing its elastic modulus with increased plasticity. The study thus quantifies effect of single-dose 50 Gy radiation on human bone, which in turn is necessary for designing improved radiation dosage during ECRT and for better understanding post-operative care.

Outcome Analysis of Neonates following Laparotomy for Acute Abdomen: A Prospective Study

Background Low and middle-income countries (LMIC) bear the majority of the global pediatric surgical burden. Despite increasing volume of pediatric surgeries being performed in LMIC, outcomes of these surgeries in low and middle-income countries remain unknown due to lack of robust data. Objective The objective of our study was to collect data on and evaluate neonatal surgical outcomes at a tertiary level center in India. Method The surgical outcomes data of all neonates undergoing laparotomy between February 15, 2015 and October 14, 2015, at Sir Ganga Ram Hospital, New Delhi, India was collected prospectively. Descriptive statistics were used to determine the rates of various postoperative outcomes. Result A total of 37 neonatal surgeries were performed during the study period. The mean age of the neonates on the day of surgery was 7 days (range: 1-30 days). Most of the neonates (72.9%, n=27) were males. About 40% (n=15) of the neonates were preterm and 15 (40.5%) of them were small for gestational age. In our study, 10 neonates (28.6%) needed ventilation for 48 hours or less after surgery and 5 neonates (13.5%) were kept Nil per Oral (NPO) postoperatively for more than 10 days. Out of 37 neonates, 4 (10.80%) developed a surgical site infection and 8 neonates (21.6%) had postoperative sepsis. The in-hospital mortality rate among neonates undergoing laparotomy during the study period was 8.1 deaths per 100 neonates. Conclusion Co-ordination of care among pediatric surgeons, neonatologists, nursing and anesthesia team is required for optimal surgical outcome.

Recent advancements and new perspectives in animal models for Neurocysticercosis immunopathogenesis

Neurocysticercosis (NCC), one of the most common parasitic diseases of the central nervous system, is caused by Taenia solium. This parasite involves two hosts, intermediate hosts (pig and human) and a definitive host (human) and has various stages in its complex life cycle (eggs, oncosphere, cysticerci and adult tapeworm). Hence, developing an animal model for T. solium that mimics its natural course of infection is quite challenging. We have reviewed here the animal models frequently used to study immunopathogenesis of cysticercosis and also discussed their usefulness for NCC studies. We found that researchers have used mice, rats, guinea pigs, dogs, cats and pigs as models for this disease with varying degrees of success. Mice and rats models have been utilized extensively for immunopathogenesis studies due to their relative ease of handling and abundance of commercially available reagents to study these small animal models. These models have provided some very exciting results for in-depth understanding of the disease. Of late, the experimentally/naturally infected swine model is turning out to be the best animal model as the disease progression closely resembles human infection in pigs. However, handling large experimental animals has its own challenges and limitations.

Profile of Caesarean Section at Kathmandu Medical College

BACKGROUND

There is a world-wide rise in caesarean section rateduring the last three decades and has been a cause of alarm and needs an in-depth study. The objective of this study was to determine the rate and clinical indications of Caesarean Section.

METHODS

A hospital based study was carried out from 15th June 2015 to 15th January 2016 in Department of Obstetrics and Gynecology at Kathmandu Medical College, Sinamangal, Nepal. Patients who delivered by caesarean section were included in the study. Basic demographic data and clinical indications were noted.

 Results: A total of 1172 deliveries were carried out during the study period. Total number of caesarean section was 537 accounting to 45.81%. Most of the patients were of the age group of 25-29 years (42.8%). Most of the patients were primigravida (n=274; 51%). Emergency caesarean section was 411 (76.5%) and elective caesarean section was 126 (23.4%). Multigravida (71%) underwent more elective procedure than primigravida (25. 39%).The most frequent indication was fetal distress19.55% (n=105), failed induction 19.73%(n=106), and previous caesarean section 21.3% (n=115).

CONCLUSIONS

The rate of cesarean section is quite high than that recommended by WHO which is (10-15%). Most of the caesarean sections were emergency caesarean section with previous caesarean being the leading cause.

Polymerase chain reaction (PCR) based amplification of hmcp3 and hmcp6 cysteine protease genes of Haemonchus contortus from small ruminants

Haemonchus contortus is a haematophagous nematode in small ruminants population and causes anaemia, weakness and mortality especially in young animals. In the present study, hmcp3 partial gene of 836 bp and hmcp6 full length gene of 1041 bp were amplified from the cDNA of Bareilly isolate of adult male H. contortus by polymerase chain reaction. Further gene characterization and expression studies are warranted to know the immunoprophylactic potential of hmcp3 and hmcp6 proteins of H. contortus.

Competition in Indian Banking

It is widely perceived that competition in the Indian banking sector has increased since the inception of the financial sector reforms in 1992. Using annual data on scheduled commercial banks for the period 1996–2004, the article evaluates the validity of this proposition in the Indian context. The empirical evidence reveals that Indian banks earn revenues as if under monopolistic competition.

Primary lymphoma of CNS, mycophenolate mofetil and lupus

Lymphoproliferative disorders are known to complicate immunosuppressive therapy and two cases of primary lymphoma of CNS (PCNSL) have previously been described in association with mycophenolate mofetil (MMF) treatment. We report the third case of PCNSL in a patient with lupus nephropathy while on MMF treatment. PCNSL may be seen more frequently considering the increased use of MMF in immunosuppressant responsive conditions.

Leg Ulcers and Oedema: A Study Exploring the Prevalence, Aetiology, and Possible Significance of Oedema in Venous Ulcers

Oedema is commonly associated with venous leg ulcers, and is thought to discourage wound healing. However, little attention has been paid to the mechanism or significance of oedema in this condition. This study assessed the prevalence of oedema and lymphatic insufficiency and their influence on wound healing amongst 56 patients. Two populations were studied – community and hospital-managed, with an almost equal number of cases in each. The presence of oedema and lymphatic insufficiency was assessed clinically and, the duration of the current ulcer was used as an indicator of healing rate.

Oedema was present in 55% of patients, but its prevalence in the community-treated group was much greater than in the hospital-treated group. Lymphatic insufficiency was present in 22% of patients with an equal prevalence in the two groups. The presence of oedema was associated with a longer duration of ulcer whereas the use of diuretics was associated with a shorter duration. This suggests that oedema may be an important factor in discouraging the healing of ulcers.

Greater attention should be paid clinically to the prevention of oedema, as its presence suggests inadequate treatment and a failure to heal.

Immediate tangential excision accelerates wound closure but does not reduce scarring of mid-dermal porcine burns

Current evidence supports the use of excision to remove eschar from deep dermal and full-thickness burns. However, the role of excision of mid-dermal burns remains unclear. This study aimed to develop a porcine model that could produce reproducible middermal thermal burns that undergo tangential excision; and investigate the effects of immediate tangential excision (30 minutes postburn) on healing and scarring. An aluminum bar preheated in hot water (70°C) was applied for 20 or 30 s to produce a total of sixteen mid-dermal burns per pig on each of six pigs. Thirty minutes after burn creation, half of the burns were tangentially excised. Four partial- thickness wounds per pig were created as controls. Depth of burn injury (1 and 24 h), reepithelialization (7 and 10 d) and scar depth (28 d) were assessed microscopically. Total scar surface area was grossly evaluated on day 28. Exposure of porcine skin to a preheated aluminum bar at 70 °C for 20 or 30 sec resulted in reproducible mid-dermal burns, where immediate excision enhanced complete wound closure as judged by complete re-epithelialization, but did not reduce initial depth of injury, scar contraction and scar depth. Immediate surgical intervention is sufficient to enhance wound closure, but not to mitigate mid-dermal burn scar formation. This work provides a suitable animal model to evaluate novel therapies that may be used to inhibit burn progression, accelerate wound closure and decrease scarring, especially those therapies unable to penetrate burn eschar.

Effect of non-genetic factors on the prevalence of Stilesia globipunctata in the goat

Despite its high prevalence and pathogenicity, Stilesia globipunctata is a neglected cestode infection of ruminants in the tropics and sub-tropics. The present study reports the effect of sex, age, year and month on the prevalence of S. globipunctata in the goat. A total of 5208 eviscerated intestines of the goat carcasses were screened for a period of seven years, from January 2001 to December 2007. The overall prevalence of 36.6 % was significantly affected by the factors studied (P<0.05). Male goats were more susceptible to the S. globipunctata infection than that of female (P<0.05). Goat aged between 6 months and 1 year were found to be significantly more susceptible (P<0.05) which was followed by animals between 1 and 4 years of age and then more than 4 years of age. Morbidity was high (59 to 86 %) in animals of less than one year of age. The striking observation was that the prevalence peaked during monsoon and at nadir in May.

Evaluation of immunogenicity and protective efficacy of a liposome containing Brucella abortus S19 outer membrane protein in BALB/c mice

The use of liposome as an adjuvant and a vaccine carrier has been cited previously in the literature. It has also been shown to be effective in enhancing the immunogenicity of vaccine candidates. BALB/c mice immunized subcutaneously with outer membrane protein (OMP) of Brucella abortus S19 vaccine strain entrapped in a commercial cationic liposome (S19-OMP-liposome) for vaccine delivery, showed enhanced protection (P<0.05) compared to groups of mice inoculated with S19 OMP alone, S19 live B. abortus vaccine and liposome alone, when challenged intra-peritoneally with virulent B. abortus strain 544 at 30 days post-immunization (DPI). The S19-OMP-liposome preparation was found to be safer compared to the live B. abortus S19 vaccine at 15 days post challenge (DPC), as evidenced by the significant difference in spleen weight between S19-OMP-liposome, S19 OMP and S19 live as well as the liposome control groups (P<0.01). Antibody isotype response profiles of the experimental groups indicated that the immune response was Th1 cell mediated. The protective advantage conferred to mice immunized with S19-OMP entrapped in liposome over those immunized with the live B. abortus S19 version, could probably be related to the significantly different response of IgG2b at 30 DPI (P<0.01), IgG2a (P<0.01), IgG2b (P<0.01) and IgG3 (P<0.05) at the DPC stages, respectively.