Rete middle cerebral artery presenting with a ruptured aneurysm

The developmental anomaly of the middle cerebral artery (MCA) is a rare occurrence. Rete MCA, also known as "unfused," "twig-like," and aplastic MCA, is an even rarer anomaly. These immature rete vessels are prone to flow-related aneurysms which rupture themselves presenting with intraparenchymal hematoma. We here with present a case of rete MCA with a ruptured aneurysm and discuss its pathophysiology and management.

Angioembolization of rectal stent induced inferior mesenteric artery pseudoaneurysm

Bleeding is a lesser-known complication of rectal self-expandable metal stents (SEMS). Most of these bleedings are self-limiting. Life threatening bleeding as a complication of SEMS reported only rarely. In the present paper, we are reporting a rare case of near fatal intraluminal bleeding from rectal SEMS. Traumatic pseudoaneurysm formed in superior rectal branch of the inferior mesenteric artery because of pressure induced by rectal stent. Severe bleeding leads to haemorrhagic shock. Patient was stabilized and angioembolization of pseudoaneurysm with superior rectal branch of inferior mesenteric artery was done. Bleeding stopped post procedure and patient discharged in stable condition. This case presentation highlights the fact that we should decide management strategy for a patient in multidisciplinary meeting and utilize the available resources in best possible ways. Though rectal stents are good alternatives, they have their own set of complications. These should be considered while deciding strategy for the upfront stoma versus rectal stent. For cases as in this article upfront stoma may have avoided the associated complication.  

Impact of atmospheric anthropogenic nitrogen on new production in the northern Indian Ocean: constrained based on satellite aerosol optical depth and particulate nitrogen levels

Aerosols are one of the significant external sources of soluble reactive nitrogen to the surface ocean and their deposition affects the primary productivity. Owing to rapid industrialization over South and Southeast Asia, an increasing trend in atmospheric pollutants was observed over the northern Indian Ocean (NIO). To assess the contribution of the aeolian supply of inorganic nitrogen to the NIO, the available compositional data of marine aerosols collected over this basin between 2001 and 2020 were compiled. Based on the observed relationship of mass load, and particulate nitrate and ammonium concentrations with the corresponding satellite-derived anthropogenic aerosol optical depth (AAOD), the temporal, spatial, and long-term variabilities were derived for the past two decades. In particular, high aerosol mass load, nitrate and ammonium levels were observed in the coastal aerosols of peninsular India during fall and winter and they were low in summer. The atmospheric input of inorganic nitrogen to the Arabian Sea is higher (AS; 1.7 TgN per year) compared to that of the Bay of Bengal (BoB; 0.9 TgN per year) and accounts for ∼30% of the total external sources of nitrogen to the NIO. The new production, supported by external sources of nitrogen, contributes to ∼23 and 53% of export production to the oxygen minimum zone (OMZ) in the AS and BoB respectively. A significant rate of increase in the aerosol mass load (0.05-1.67 μg per m³ per year), and nitrate (0.003-0.04 μg per m³ per year) and ammonium (0.006-0.11 μg per m³ per year) concentrations was observed between 2001 and 2020, likely because of the increased emission of anthropogenic pollutants over South and Southeast Asia and their subsequent long-range atmospheric transport to the NIO. Overall, these results suggest that an enhanced contribution of atmospheric nitrogen may potentially increase (1) the N/P ratio of the surface ocean that impacts phytoplankton composition, (2) export production to the OMZ leads to intensification, and (3) sequestration of atmospheric CO₂. A decrease in primary production due to global warming is reported due to a decrease in vertical nutrient supply; however, the increase in atmospheric deposition of nutrients may compensate for this. Therefore, ocean models must be coupled with atmospheric models to better constrain the oceanic response to climate change in the NIO.

Decadal variations in natural and anthropogenic aerosol optical depth over the Bay of Bengal: the influence of pollutants from Indo-GangeticPlain

Perennial increase in atmospheric pollution over the Bay of Bengal (BoB) and South China Sea is reported due to increase in human population and industrial activity in South and Southeast Asia. Based on total aerosol optical depth (AOD) derived from MODIS (moderate resolution imaging resolution imaging spectroradiometer), natural and anthropogenic fractions were derived. The seasonality and spatial variability in rate of increase in total, natural, and anthropogenic AOD fractions were examined over the BoB using data collected between 2001 and 2019. Both total and anthropogenic AOD displayed statistically significant rate of increase in the northwest BoB (NWB) and western coastal BoB (WCB) regions during 2001 to 2019 whereas the long-term changes are insignificant in the other regions of BoB. Significant increase in AOD in the NWB and WCB regions is mainly contributed by dominant outflow of anthropogenic emissions from Indo-Gangetic Plain (IGP) area of Indian subcontinent. The magnitude of AOD decreased by half from northern BoB to equatorial region due to increase in distance from the source region. The contribution of anthropogenic AOD was >70% to total AOD with higher contribution during winter and lower during summer. The rate of increase in both total and anthropogenic AOD was close to 0.104 and 0.099 per decade in the NWB and 0.069 and 0.059 per decade in the WCB region between 2001 and 2019. The rate of increase in total and anthropogenic AOD decreased from 2001-2009 (0.164 and 0.115 per decade respectively) to 2010-2019 (0.068 and 0.076 per decade respectively) in the NWB region. Significant increase in anthropogenic AOD by 50 and 30% was observed during El Niño and La Niña periods respectively than normal year in both northwest BoB (NWB) and western coastal (WCB) regions due to change in strength and direction of winds. Although some fraction of anthropogenic AOD is found over the entire BoB, significant rate of increase in anthropogenic AOD is found only about 23% of the area of BoB than hitherto reported as entire BoB. The impact of atmospheric deposition of anthropogenic aerosols on biogeochemical processes, such as primary production and ocean acidification, needs further evaluation.

Paediatric brain abscesses in tribal region of India

Introduction: Brain parenchymal abscesses are relatively infrequent but potentially serious infections in the paediatric population. Surgical intervention in addition to a prolonged administration of antibiotics is generally appropriate management. Aims and objective: We performed this study to assess the clinical profile, aetiology and outcome of paediatric brain abscess which are treated surgically only by aspiration in the tribal region of Rajasthan. Material and method: A single-centre retrospective study was conducted over a 5 year period (2014–2019) in the department of neurosurgery in RNT medical college, Udaipur, Rajasthan. We treated approx 60 patients of which 25 patients treated conservatively and 5 patient treated by craniotomy and abscess excision. So only 30 patient included in our study in which abscess treated by aspiration only. Patients<18 years of age with a confirmed intra-parenchymal abscess were included. Patient records were reviewed for abscess location, microbiology results, Clinical features, Surgical intervention, and outcome using the Glasgow Outcome Score at 3 months. Result: 11 patients had an abscess in the temporal lobe and Streptococcus was the most common causative micro-organism (n¼15). 25 patients (80%) had an identifiable source which included: ENT infections, congenital cardiac malformations, recent dental surgery and meningitis. The most common symptom is fever f/b headache, seizure and vomiting. But despite previous studies seizure (10/30) presentation is comparatively more. All 30 patients underwent aspiration. Conclusion: In tribal regions of India ENT infections are a more common source of brain abscess because of poor hygiene and illiteracy and their ignorance of ENT infections and also not taking seriously to fever, headache and other health issues. But at present, there are also decreasing trends of brain abscess by ENT infections and rising trends by congenital heart disease which is a good sign that the health and educational infrastructure is strengthening in the tribal region also.

Characteristics of Circulatory γδ T cells in Patients with Symptomatic Chronic Hepatitis B Infection

Hepatitis B is a viral infection that can cause serious liver disease. Chronic hepatitis B (CHB) infection places individuals at higher risk of developing cirrhosis of the liver and hepatocellular cancer. Immune dysfunction, including altered distribution and functional status of T cell immunity, is a contributor to hepatitis B virus (HBV) pathogenesis. In this study, we examined the distribution of circulating γδ T cell subpopulations and levels of cell surface expression of suppressive markers on γδ T cells in individuals with CHB infection and clinical liver disease. A significantly higher proportion of terminally differentiated (T_EMRA) (CD27^-CD45RA⁺) γδ T cells along with significantly lower percentages of central memory (CD27⁺CD45RA^-) and effector memory (CD27^-CD45RA^-) γδ T cells were observed in peripheral blood of these individuals. The expression of exhaustion markers-Tim-3 and Lag-3 was elevated in γδ T cells from CHB-infected individuals compared with healthy controls (HC) and blockade of these exhaustion markers resulted in restoration of interferon gamma (IFN-γ) secretion by γδ T cells. In addition, γδ T cells from CHB patients expressed increased levels of CD69, another important regulator of immune responses. Together, these results suggest that CHB patients with clinical sign of liver disease have T_EMRA γδ T cells with a potentially exhausted phenotype that may in turn impair their immunoregulatory role and facilitate pathogenesis of CHB disease.

Urine Extracellular Vesicle GATA2 mRNA Discriminates Biopsy Result in Men with Suspicion of Prostate Cancer

PURPOSE

Prostate specific antigen has limited performance in detecting prostate cancer. The transcription factor GATA2 is expressed in aggressive prostate cancer. We analyzed the predictive value of urine extracellular vesicle GATA2 mRNA alone and in combination with a multigene panel to improve detection of prostate cancer and high risk disease.

MATERIALS AND METHODS

GATA2 mRNA was analyzed in matched extracellular vesicles isolated from urines before and after prostatectomy (16) and paired urine and tissue prostatectomy samples (19). Extracellular vesicle GATA2 mRNA performance to distinguish prostate cancer and high grade disease was tested in training (52) and validation (165) cohorts. The predictive value of a multigene score including GATA2, PCA3 and TMPRSS2-ERG (GAPT-E) was tested in both cohorts.

RESULTS

Confirming its prostate origin, urine extracellular vesicle GATA2 mRNA levels decreased significantly after prostatectomy and correlated with prostate cancer tissue GATA2 mRNA levels. In the training and validation cohort GATA2 discriminated prostate cancer (AUC 0.74 and 0.66) and high grade disease (AUC 0.78 and 0.65), respectively. Notably, the GAPT-E score improved discrimination of prostate cancer (AUC 0.84 and 0.72) and high grade cancer (AUC 0.85 and 0.71) in both cohorts when compared with each biomarker alone and PT-E (PCA3 and TMPRSS2-ERG). A GAPT-E score for high grade prostate cancer would avoid 92.1% of unnecessary prostate biopsies, compared to 61.9% when a PT-E score is used.

CONCLUSIONS

Urine extracellular vesicle GATA2 mRNA analysis improves the detection of high risk prostate cancer and may reduce the number of unnecessary biopsies.

Spatial and temporal variability in concentration and characteristics of aerosols at Visakhapatnam (east) and Goa (west) coasts of India

Knowledge on the variability in quantity and compositions of various size groups of aerosols is important to understand their sources and their role in biogeochemical and climate processes. Here, we studied total suspended particles (TSP), PM₁₀ and PM_2.5 for their quantitative and water soluble compositional (F^-, Cl^-, SO₄^2-, NO₃^-, NH₄⁺, Na⁺, K⁺, Ca²⁺, and Mg²⁺) distributions, and to understand their nature and potential sources at Goa and Visakhapatnam on the west and east coasts, respectively, of India. While the mean concentrations of TSP were found to be 117 ± 44 and 85 ± 51 μg/m³ its maximal levels occurred in spring intermonsoon (SIM; 141 ± 52) and winter monsoon (WM; 155 ± 145 μg/m³) seasons at Goa and Visakhapatnam, respectively. PM₁₀ and PM_2.5 exhibited higher ranges at Visakhapatnam than Goa. The increase in PM_2.5 abundance from WM to SIM at Visakhapatnam seems to occur in coincidence with decrease in TSP favored by topography and ambient meteorological conditions. Locally released and seasonally transported (from land and sea) constituents contributed to the observed variability in aerosol compositions. Sulphate dominated the aerosol composition at both Goa (57-64%) and Visakhapatnam (43-55%) followed by NO₃^- (5-16% and 6-18%, respectively) where the former component was higher in PM₁₀ and PM_2.5. The NO₃^- was more in TSP. Relations between SO₄^2- and NH₄⁺ suggested possible presence of NH₄HSO₄. Examination of ionic ratios and balance suggested near neutrality in PM₁₀ and PM_2.5 while TSP was acidic at the both locations. Notable relations between Ca²⁺ and NO₃^-, particularly in PM₁₀ at Goa, indicated their release from mining related activities.

Genetic characterisation of influenza A(H1N1)pdm09 viruses circulating in Assam, Northeast India during 2009-2015

Introduction

Influenza A(H1N1)pdm09 virus, since its identification in April 2009, has continued to cause significant outbreaks of respiratory tract infections including pandemics in humans. In the course of its evolution, the virus has acquired many mutations with an ability to cause increased disease severity. A regular molecular surveillance of the virus is essential to mark the evolutionary changes that may cause a shift to the viral behavior.

Materials and Methods

Samples of Throat/Nasal swabs were collected from a total of 3715 influenza-like illness cases and screened by Real-time Reverse Transcription-Polymerase Chain Reaction for influenza viruses. Nucleotide sequence analysis was done to identify changes in antigenicity of the virus strains.

Results

The present study describes the molecular characteristics of influenza A(H1N1)pdm09 viruses detected in Assam of Northeast India during 2009-2015. Influenza A viruses were detected in 11.4% (425/3715), of which influenza A(H1N1)pdm09 viruses were detected in 41.4% (176/425). The nucleotide sequencing of influenza A(H1N1)pdm09 viruses revealed a total of 17 and 22 amino acid substitutions in haemagglutinin (HA) and neuraminidase (NA) genes of the virus, respectively, compared to contemporary vaccine strain A/California/07/2009. The important mutations detected in HA genes of A/Assam(H1N1)pdm09 strains included E391K, K180Q and S202T. Mutation 'N248D' which has an ability to develop oseltamivir resistance was also detected in NA gene of A/Assam(H1N1)pdm09 strains.

Conclusions

Regular molecular surveillance of influenza A(H1N1)pdm09 is important to monitor the viral behavior in terms of increase virulence, drug resistance pattern and emergence of novel strains.

Molecular characterisation of virulent gene vacA in Helicobacter pylori clinical isolates from patients with gastroduodenal diseases in Assam, India

Background

Helicobacter pylori, the gastric bacterium, is widely known to be one of the most genetically diverse group of organisms whose pathogenesis as well as the diversity in infection outcome may be attributed to a variety of virulent genes.

Aim

This study aimed to study the molecular profile of H. pylori vacA gene by determining the phylogenetic relatedness and genetic diversity of the strains isolated in this region with those of other geographical regions.

Materials and Methods

A total of twenty H. pylori clinical strains were isolated from randomly selected 100 patients suffering from gastroduodenal diseases as well as endoscopically normal patients in a cross-sectional hospital-based setting from January 2016 to May 2017. VacA signal sequence and mid regions of H. pylori were amplified by polymerase chain reaction followed by DNA sequencing and phylogenetic analysis.

Results

VacA s1m1 allelic variant was more prevalent in our study, regardless of the clinical outcomes. Phylogenetic analysis of VacA s1 strains revealed clustering of most of the strains. VacA m1 strains clustered with Bangladesh strains which is a country nearest to India.

Conclusion

Prevalence of VacA s1m1 strains may account for high risk of transmission of this gastric pathogen and the overall risk of acquiring infection. Phylogenetic analysis results suggests the prevalence of high genetic diversity in our region. Our findings may aid in developing a better understanding of the genetic structure of H. pylori and the pathophysiology of associated diseases, thus facilitating the implementation of various treatment options.

Cost-effective way to reduce stimulant-abuse among gay/bisexual men and transgender women: a randomized clinical trial with a cost comparison

OBJECTIVES

A randomized controlled study was conducted with 422 homeless, stimulant-using gay/bisexual (G/B) men and 29 transgender women (n = 451) to assess two community-based interventions to reduce substance abuse and improve health: (a) a nurse case-managed program combined with contingency management (NCM + CM) versus (b) standard education plus contingency management (SE + CM).

STUDY DESIGN

Hypotheses tested included: a) completion of hepatitis A/B vaccination series; b) reduction in stimulant use; and c) reduction in number of sexual partners.

METHODS

A deconstructive cost analysis approach was utilized to capture direct costs associated with the delivery of both interventions. Based on an analysis of activity logs and staff interviews, specific activities and the time required to complete each were analyzed as follows: a) NCM + CM only; b) SE + CM only; c) time to administer/record vaccines; and d) time to receive and record CM visits. Cost comparison of the interventions included only staffing costs and direct cash expenditures.

RESULTS

The study outcomes showed significant over time reductions in all measures of drug use and multiple sex partners, compared to baseline, although no significant between-group differences were detected. Cost analysis favored the simpler SE + CM intervention over the more labor-intensive NCM + CM approach. Because of the high levels of staffing required for the NCM relative to SE, costs associated with it were significantly higher.

CONCLUSIONS

Findings suggest that while both intervention strategies were equally effective in achieving desired health outcomes, the brief SE + CM appeared less expensive to deliver.

Intrapancreatic Splenule in a Pancreas Allograft: Case Report

A 16-year-old white man was involved in a motor vehicle collision and suffered head, chest, and abdominal trauma. Despite initial resuscitative efforts, he progressed to brain death and was designated to be an organ donor by his family. He had no earlier medical or surgical history and no high-risk behaviors. Blood work revealed normal creatinine, liver function tests, lipase, and amylase. Viral serologies were negative except for cytomegalovirus IgG and Epstein-Barr virus nucleic acid. Imaging revealed a right kidney contusion, a manubrial fracture, and fractures of right first rib and bilateral scapulae. No other abdominal trauma was identified, specifically to the pancreas, duodenum, or spleen. Our transplant center accepted the pancreas from this donor. During back-table inspection of the pancreas, a 1.5 × 1.5 cm dark purple rubbery mass was identified within the parenchyma of the pancreas in the tail. An incisional biopsy of the lesion was sent for frozen section, which yielded a mixed inflammatory infiltrate consisting of neutrophils and lymphocytes and an overlying fibrous capsule. The diagnosis of lymphoma or another neoplasm could not be definitely ruled out. Owing to uncertainty in diagnosis, the entire lesion was excised along with the distal pancreas with the use of a linear stapler. The staple line was oversewn with running 4-0 polypropylene suture, and the pancreas was transplanted. After surgery, the pancreas allograft functioned well with a small pancreatic leak, which had resolved by the first postoperative outpatient visit.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: Present perspectives and future horizons

AIMS

Our comprehensive review highlights the drug development and pharmacogenomics leading to the recent approval of PCSK9 inhibitors. We also review the anticipated future advances into the uses of PCSK9 inhibition.

BACKGROUND

Despite the present advances in pharmacotherapy, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality worldwide. Low density lipoprotein-cholesterol (LDL-C) lowering is the primary target for ASCVD risk reduction, showing demonstrable benefits in mortality. However, 70% of events occur even in the presence of statins. This residual risk may be approached with additional LDL-C reduction. Statin intolerance is a common clinical concern affecting adherence and the benefit with statins. There is also significant variation of individual lipid-lowering. Following rapid development, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have progressed from genetic observations, to mechanistic studies, to closer realization of the goal of CVD risk reduction. This review discusses the science behind PCSK9 inhibition, evidence of trials involving efficacy and safety, and reflections of its present and future role in clinical care, especially in high-risk patients with ASCVD, persons with suboptimal responses to statins and familial hyperlipidemia. Monoclonal antibodies have demonstrated LDL-C lowering of up to 57% as monotherapy and up to 73% when added to statins. Statins have limited efficacy in reduction of LDL-C due to an increased number of LDL-receptors. Elevated lipoprotein (a) levels may also be significantly lowered by PCSK9i. The journey from discovery to PSCK9 target validation took less than five years, and development and approval of therapeutic modalities for PCSK9 inhibitors happened over the next seven. This review highlights the drug development and pharmacogenomics leading to the recent approval of two agents, alirocumab and evolocumab, with a third bococizumab, and other novel approaches to the pathway pending.

DATA SYNTHESIS

We searched MEDLINE database via Pubmed for reviews, research publications and relevant trials available on PCSK9 inhibition.

CONCLUSION

Despite decades of medical advances, ASCVD remains one of the major causes of morbidity and mortality worldwide. Statin use has multiplied since the validation of LDL hypothesis, however, it is undeniable a more effective and well-tolerated agent is needed in significant number or patients. With the arrival of the era of unprecedented CV protection with PCSK9 inhibition, this exciting new therapy holds a pivotal promise as the future of lipid management. The data available already indicate safety, tolerability and superb efficacy of these agents, which are already changing contemporary cholesterol management. The rapid translation of innovative basic science research into drug development may lead to CV outcomes reduction and confirm that this pathway will become prominently utilized.

Seroprevalence of Scrub Typhus Infection in Arunachal Pradesh, India

INTRODUCTION

Scrub typhus is a major reason for febrile illness, caused by a bacterium Orientia tsutsugamushi, a rickettsial pathogen. Few outbreaks of scrub typhus have been reported from Arunachal Pradesh in recent past. However, there is lack of seroprevalence data from the region. In this regard, this study was undertaken using archival serum sample available from seven districts of Arunachal Pradesh.

METHODOLOGY

This serological study was conducted in Regional Medical Research Center for NE Region, Dibrugarh. Reactivity to IgG class of antibodies against scrub typhus was done using Scrub typhus detect IgG ELISA kit as per manufacturer's protocol.

RESULT

Seroprevalence of scrub typhus in seven districts of Arunachal Pradesh was found to be 40% (120/300). The age-specific scrub typhus seroprevalence rose steadily from 5.6% in children <10 years of age to 61.8% in persons aged ≥40 years (p = 0.0001). Prevalence is lowest in Papumpare (25.9%) and highest in East Siang (72.5%) (p = 0.0001). The seroprevalence in males and females was very similar, however, the female prevalence increases from age group ≥30 years (p = 0.053). Moreover, among the farmers, the seroprevalence is higher (58.3%) (p = 0.0001).

CONCLUSIONS

As clinical symptoms overlap with other viral/bacterial infections, scrub typhus infection should be considered in differential diagnosis of any acute febrile illness in this part of the country. In view of the high prevalence, empirical therapy of doxycycline/azithromycin may be done in cases of undiagnosed fever. Active surveillance has to be done to understand exact magnitude, epidemiological aspects, and distribution of vector and disease of this reemerging neglected tropical disease.

Typing of Plasmodium falciparum DNA from 2 years old Giemsa-stained dried blood spots using nested polymerase chain reaction assay

A panel of 129 Giemsa-stained thick blood spots (TBS) confirmed for Plasmodium falciparum infection having different levels of parasite density were collected from a malaria endemic area. DNA was extracted and nested polymerase chain reaction (PCR) assay was performed to amplify P. falciparum DNA. Nested PCR assay successfully amplified P. falciparum DNA at a very low parasitaemia of ~10 parasites/μl of blood. Current PCR assay is very simple and can be used retrospectively to monitor the invasion and prevalence of different Plasmodium species in endemic areas.

Outbreak of influenza-like illness investigated during August 2013 near Indo-China border of Arunachal Pradesh, Northeast India

During August 2013, an outbreak of influenza-like illnesses (ILI) was investigated in Monigong area, near Indo-China border of Arunachal Pradesh, Northeast India. Influenza type A/H3N2 was detected by RT-PCR in 33.3% (8/24) of ILI cases. Sequence analysis of HA and NA genes revealed eight and five amino acid substitutions, respectively in Monigong H3N2 (Mo/H3N2) strains as compared to vaccine strain A/Victoria/361/2011. Four non-synonymous substitutions, three localizing at antigenic sites T144A, A; R158G, B; L173S, D, and one H9Y in close proximity to a potential glycosylation site aa8 in HA1 domain along with the substitution T329N in NA are likely to influence the antigenicity/virulence of Mo/H3N2 viruses. J. Med. Virol. 88:1999-2003, 2016. © 2016 Wiley Periodicals, Inc.

Post hepatectomy liver failure: concept of management

BACKGROUND

In literature, the reported mortality of posthepatectomy liver failure is <5 % and morbidity is 15-30 %. Around 3-8 % of patients develop liver failure after major hepatic resection.

OBJECTIVE

The objective of the study was to provide current definitions and managing posthepatectomy liver failure (PHLF) as per severity and ISGLS grading.

METHOD

A systemic search of pubmed indexed articles was done and relevant articles were selected to formulate latest guidelines for PHLF.

CONCLUSION

We were able to make an algorithm for standardizing management so as to identify and treat PHLF as early as possible.

Simultaneous bilateral laparoscopic adrenalectomy for pheochromocytoma in multiple endocrine neoplasia (MEN) syndrome: Case report with review literature

INTRODUCTION

Laparoscopic adrenalectomy has gained favour as a preferred surgical approach in the multiple endocrine neoplasia (MEN) type 2 patients. Currently, there is limited literature on bilateral simultaneous laparoscopic adrenalectomy in MEN 2 syndrome. We reported two cases of bilateral pheochromocytoma associated with MEN 2 syndrome cured by simultaneous bilateral laparoscopic adrenalectomy.

PRESENTATION OF CASE

First patient presented with big lips since childhood and episodic abdominal pain. On investigations, he was diagnosed with features of MEN 2B syndrome. Second patient was hypertensive and presented with abdominal pain. On evaluation she had features of MEN 2A syndrome.

DISCUSSION

Minimally invasive approach was preferred in both cases. Bilateral simultaneous adrenalectomies were uneventfully done with acceptable operative time and blood loss with rapid perioperative recovery. These cases highlighted the feasibility of laparoscopic simultaneous bilateral adrenalectomy for pheochromocytomas in MEN 2 syndrome.

CONCLUSION

Laparoscopic simultaneous bilateral adrenalectomy is a safe feasible and preferable technique for pheochromocytomas associated with MEN 2 syndrome.

Anti-C reactive protein antibodies in Indian patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is characterized by over production of autoantibodies. C-reactive protein (CRP) is a phylogenetically highly conserved plasma protein that participates in the systemic response to inflammation. Anti-CRP antibodies might have biological functions of pathogenetic interest in SLE. We evaluated anti-CRP antibodies in Indian SLE patients and their association with anti-dsDNA antibodies and complement levels (C3 and C4). One hundred SLE patients diagnosed according to the American College of Rheumatology criteria were included. Disease activity was assessed using SLE disease activity index (SLEDAI). Anti-CRP autoantibodies were detected by enzyme linked immunosorbent assay. Anti-dsDNA antibodies were detected by indirect immunofluroscence test (Euroimmun Lubeck, Germany). High sensitivity CRP and complement levels (C3, C4) were detected using a Nephelometer. (BN ProSpec, Dade Behring, Germany). Anti-CRP antibodies were detected in 26% of SLE patients. Mean age of disease onset among anti-CRP positives was 22.4 ± 7.5, and 26.6 ± 9.3 years among anti-CRP negatives (P > 0.05). Anti-dsDNA positivity was significantly higher among anti-CRP positives (32.7%) as compared to anti-CRP negatives (16%) (P = 0.00519). No statistically significant difference was observed in SLEDAI scores of anti-CRP positive group and anti-CRP negative group (P > 0.05). We observed a positive correlation between anti-CRP antibodies and anti-dsDNA antibodies.

Prioritizing areas for malaria control using geographical information system in Sonitpur district, Assam, India

OBJECTIVE

To identify the malaria hot spots at health subcentre level in an endemic district using a geographical information system (GIS). The results will be useful for rapid retrieval of malaria information, and to prioritize malaria control efforts in identified hot spots.

STUDY DESIGN

Extraction, analysis and synthesis of relevant data.

METHODS

Malaria epidemiological data from 2006 to 2009 were analysed to determine the annual parasitic index, slide positivity rate, annual blood examination rate and Plasmodium falciparum percentage for each health subcentre in the district. Maps were produced using GIS, and integrated to identify the malaria hotspots.

RESULTS

Out of 288 health subcentres, GIS identified 10 hot spots at extremely high risk of malaria and 14 hot spots at high risk of malaria. Malaria may flare up in these hot spots whenever favourable transmission conditions arise. Health authorities have been advised to establish control measures in these selected hot spots for timely prevention.

CONCLUSION

There is a need for adequate monitoring and allocation of available resources for better interventions in the malaria hotspots. The GIS model used in this study can be used, even at village or cluster level, to pin point the malaria hot spots, and information can be updated and retrieved easily.

Development and characterization of a cell line TTCF from endangered mahseer Tor tor (Ham.)

Tor tor is an important game and food fish of India with a distribution throughout Asia from the trans-Himalayan region to the Mekong River basin to Malaysia, Pakistan, Bangladesh and Indonesia. A new cell line named TTCF was developed from the caudal fin of T. tor for the first time. The cell line was optimally maintained at 28°C in Leibovitz-15 (L-15) medium supplemented with 20% fetal bovine serum (FBS). The propagation of TTCF cells showed a high plating efficiency of 63.00%. The cytogenetic analysis revealed a diploid count of 100 chromosomes at passage 15, 30, 45 and 60 passages. The viability of the TTCF cell line was found to be 72% after 6 months of cryopreservation in liquid nitrogen (-196°C). The origin of the cell lines was confirmed by the amplification of 578- and 655-bp sequences of 16S rRNA and cytochrome oxidase subunit I (COI) genes of mitochondrial DNA (mtDNA) respectively. TTCF cells were successfully transfected with green fluorescent protein (GFP) reporter plasmids. Further, immunocytochemistry studies confirm its fibroblastic morphology of cells. Genotoxicity assessment of H₂O₂ in TTCF cell line revealed the utility of TTCF cell line as in vitro model for aquatic toxicological studies.

Epidemiology and Risk Analysis of Malaria among Pregnant Women

Malaria remains a complex problem during the pregnancy, which threatens > 35 millions pregnant women every year. Malaria pathogenesis in pregnancy results in accumulation of infected RBCs in the intervillous spaces causing severe alterations leading to the reduced materno-foetal exchanges. In this article we have revisited the current evidences of clinical implications and overall burden of malaria in pregnancy. Many adverse aftermaths including, low birth weight, intrauterine growth retardation, preterm delivery, stillbirth and anemia were found associated with malaria in pregnant women. Despite of worldwide comprehensive control programmes for malaria in pregnancy, the disease control has been a daunting task everywhere. Socio cultural, economical, lack of awareness and various logistic problems compound the disease in developing countries. Thorough evidence based information and estimates, education and awareness and strengthening of prevention programmes are needed urgently to achieve success in malaria control in pregnancy.

Simultaneous infection of measles and varicella-zoster virus in a child in India

Simultaneous occurrence of measles and chickenpox in a single individual is a rare event despite the fact that each of these infections alone is very common. The clinical presentation and molecular characterization of a dual infection caused by measles and Varicella-Zoster virus (VZV) in a 3-year female child is reported for the first time from India. The child presented with high fever, cough, cervical lymphadenopathy, and maculopapular rash followed by vesicular skin rash. The child was not immunized against measles and chickenpox. The viral nucleic acids extracted from the clinical specimen were subjected to PCR-Sequencing for confirmation of a dual infection with measles and VZV. The PCR and sequence analysis from the throat swab samples confirmed the coinfection of wild-type measles (genotype D4) and Varicella-Zoster virus (PstI(+) BglI(+)). The measles virus RNA and VZV DNA could be detected successfully from a single specimen of a throat swab. The case recovered uneventfully. Dual infection with measles and VZV does occur but may be underreported in the literature.

Evaluation of POSSUM and P-POSSUM as a tool for prediction of surgical outcomes in the Indian population

BACKGROUND

Increased scrutiny and the need to institute a truly patient centered approach to surgical care has motivated the growing interest in measuring the quality of surgical care through comparative surgical audit. This study aimed to assess the validity of the POSSUM (Physiological and Operative Severity Score for enumeration of Mortality and Morbidity) and P-POSSUM (Portsmouth-POSSUM) score in predicting the risk of morbidity and mortality respectively in general surgical patients presenting with conditions of various operative severities at a tertiary care centre in Haryana, a northern state of India.

METHOD

A prospective study was performed in 100 general surgical patients including an equal number of patients in each of the four groups of operative severity i.e. minor, moderate, major, major plus. The risks of mortality and morbidity were calculated by using the POSSUM equation for morbidity and the P-POSSUM equation for mortality in each patient. The predicted risks were compared with the observed risks of mortality and morbidity and statistically analysed.

RESULTS

The difference in p value of predicted risk of morbidity by POSSUM equation and observed morbidity; calculated by chi square test was 0.756 which was not statistically significant. The difference in p value of predicted mortality by P-POSSUM equation and observed mortality; calculated by chi square test was 0.472 which was also not statistically significant.

CONCLUSION

POSSUM and P-POSSUM appear to be good and valid indices for use in the risk prediction of morbidity and mortality in the north Indian population.

Molecular epidemiology of measles in India, 2005-2010

Measles is a childhood disease that causes great morbidity and mortality in India and worldwide. Because measles surveillance in India is in its infancy, there is a paucity of countrywide data on circulating Measles virus genotypes. This study was conducted in 21 of 28 States and 2 of 7 Union Territories of India by MeaslesNetIndia, a national network of 27 centers and sentinel practitioners. MeaslesNetIndia investigated 52 measles outbreaks in geographically representative areas from 2005 through June 2010. All outbreaks were serologically confirmed by detection of antimeasles virus immunoglobulin M (IgM) antibodies in serum or oral fluid samples. Molecular studies, using World Health Organization (WHO)-recommended protocols obtained 203 N-gene, 40 H-gene, and 4 M-gene sequences during this period. Measles genotypes D4, D7, and D8 were found to be circulating in various parts of India during the study period. Further phylogenetic analysis revealed 4 lineages of Indian D8 genotypes: D8a, D8b, D8c, and D8d. This study generated a large, countrywide sequence database that can form the baseline for future molecular studies on measles virus transmission pathways in India. This study has created support and capabilities for countrywide measles molecular surveillance that must be carried forward.

Changing patterns of diet, physical activity and obesity among urban, rural and slum populations in north India

Rapid urbanization and accompanying lifestyle changes in India lead to transition in non-communicable disease risk factors. A survey was done in urban, urban slum and rural population of Haryana, India, in a sample of 4129 men and 3852 women using WHO STEPS questionnaire. A very high proportion of all the three populations reported inadequate intake of fruits and vegetables. Rural men reported five times physical activity as compared with urban and urban slum men and rural women reported seven times physical activity as compared with women in the other two settings. Mean body mass index (BMI) was highest among urban men (22.8 kg m(-2)) followed by urban slum (21.0 kg m(-2)) and rural men (20.6 kg m(-2)) (P-value < 0.01). Similar trend was seen for women but at a higher level than men. Prevalence of obesity (BMI >/= 30 kg m(-2)) was highest for urban population (male = 5.5%, female = 12.6%) followed by urban slum (male = 1.9%, female = 7.2%) and rural populations (male = 1.6%, female = 3.8%). Urbanization increases the prevalence of the studied non-communicable disease risk factors, with women showing a greater increase as compared with men. Non-communicable disease control strategy needs to address urbanization and warrants gender sensitive strategies specifically targeting women.