Serial perioperative cell-free DNA levels in donors and recipients undergoing living donor liver transplantation

BACKGROUND

Effect of anaesthesia and surgery on cell-free DNA (cfDNA) is not known. Given that surgical stress augments inflammation and injury, we hypothesized that levels of cfDNA will fluctuate during perioperative period. Therefore, in this study serial perioperative cfDNA concentration was measured in donors and recipients undergoing living donor liver transplantation (LDLT).

METHODS

Baseline, post-induction, intraoperative and post-operative plasma cfDNA levels were evaluated in 21 donors and recipients each, by Sytox green method. In addition, qPCR was performed in a subset of samples.

RESULTS

Baseline cfDNA levels were higher in recipients (37.62 ng/ml) than in donors (25.49 ng/ml). A decrease in cfDNA was observed following anaesthesia induction in both recipients (11.90 ng/ml) and donors (10.75 ng/ml). When the kinetics of the cfDNA was monitored further, an increase was noted intraoperatively in donors (46.18 ng/ml) and recipients (anhepatic phase: 56.25 ng/ml, reperfusion phase: 54.36 ng/ml). cfDNA levels remained high post-operatively. One recipient who developed post-operative sepsis had the highest cfDNA level (94.72 ng/ml).

CONCLUSION

Plasma cfDNA levels are high in recipients indicative of liver injury. Lower cfDNA levels following induction may be attributed to the subduing effect of anaesthetic agents on cell death. High cfDNA levels seen in intra- and post-operative phases reflect cellular trauma and inflammation. This similar pattern of fluctuation of cfDNA level in donors and recipients is suggestive of its possible utility as a surgical stress marker. In addition, comparable cfDNA levels in anhepatic and reperfusion phase reflect less ischemia reperfusion injury during LDLT.

Phytoplankton species diversity indices in Anjanapura reservoir, Western Ghat region, India

A qualitative study on species composition and diversity of phytoplankton flora was carried out in the Anjanapura reservoir. Water samples were collected monthly at four sites from November 2005 to October 2007 for plankton analysis. A total of 152 phytoplankton species belonging to 59 genera were recorded. The species belonging to genera Crucigenia, Pediastrum, Scenedesmus, Tetraedron, Cyclotella, Gyrosigma, Melosira, Navicula, Fragillaria, pinnularia, Synedra, Closterium, Cosmarium, Euastrum, Staurastrum, Gleocapsa, Merismopedia, Microcystis, Oscillatoria, Euglena and Phacus were found dominant. Phytoplankton density was recorded in the range of 222-1467 Org l(-1) for chlorococcales, 267-1467 Org I (-1) for diatoms, 44-889 Org l(-1) for desmids, 44-889 Org l(-1) for blue-greens and 22-1667 Org l(-1) for euglenoids. Seasonal density Shannon-Weiner diversity index (1.60-1.88) indicate that reservoir exhibited rich phytoplankton and Nygaard tropic status indices for myxophycean (1.0-1.50), chlorophycean (1.62-2.16), diatoms (0.10-0.14), euglenophycean (0.18-0.19) and compound quotient(3.25-4.66) showed that reservoir was moderately polluted. From the observed data, it could be concluded that the presence of more diverse group of phytoplankton indicate the productivity of the reservoir.

Ileal ganglioneuromatosis with adenocarcinoma in a patient with multiple neurofibromatosis

Von Recklinghausen's disease or type 1 neurofibromatosis is an autosomal dominant disease characterized by mucocutaneous neurofibromas, café-au-lait spots and involves many organs including gastrointestinal tract. Gastrointestinal involvement in neurofibromatosis is uncommon and is seen 25% patients and nearly 5% of them are only symptomatic (Shekitka and Sobin, Am J Surg Pathol 18:250-257, 1994; Tomita et al., Int J Colorectal Dis 21: 89-91, 2006).

Hypolipidemic Effect of Celastrus paniculatus in Experimentally Induced Hypercholesterolemic Wistar Rats

The objective of the present study was to evaluate hypolipidemic effect of methanolic extract of Celastrus paniculatus in experimentally induced hypercholesterolemic rats. Hypercholesterolemia was induced by feeding the animals with high fat diet. Oral administration of methanolic seed extract (50%) of Celastrus paniculatus at the optimized dose of 65 mg/kg body weight, substantially reduced the plasma total cholesterol, triglycerides and LDL cholesterol in comparison with induced hypercholesterolemic animal group and the results were comparable with the standard hypocholesterolemic drug and almost similar to the control group. Atherogenic index and liver weight of treated animals also showed significant decrease compared to the hypercholesterolemic animals. It substantially increased the HDL cholesterol level as compared to control group. A significant increase in the activities of lipoprotein lipase and plasma LCAT enhanced hepatic bile acid synthesis and thereby, increased degradation of cholesterol to neutral sterols. Furthermore, the activities of HMG-CoA reductase, glucose 6-phosphate dehydrogenase and malate dehydrogenase were significantly reduced. Histological studies showed less cholesterol deposits in the aorta of animals fed with seed extract of C. paniculatus compared to the induced hypercholesterolemic animals not given C. paniculatus supplement.

Corneal changes in type II diabetes mellitus in Malaysia

AIM

To compare corneal endothelial structure and central corneal thickness (CCT) between type II diabetics and non-diabetic control patients. To look for correlations between diabetic status and corneal findings.

METHODS

Hospital-based, observational study. 200 eyes (from 100 type II diabetic patients and 100 controls) were included. Specular microscopy and pachymetry were used to measure endothelial cell density, size, coefficient of variation in cell area, hexagonality as well as corneal thickness. Independent t-tests were used to compare variables between diabetics and controls. Pearson correlation tests were used to evaluate correlations between corneal findings and diabetic status such as duration of diabetes, haemoglobin A1c (HbA1c) level and severity of diabetic retinopathy.

RESULTS

Endothelial cell density in the diabetic group (2541.6±516.4 cells/mm(2)) was significantly lower than that in the control group (2660.1±515.5 cells/mm(2), P<0.05). The average size of endothelial cells, standard deviation (SD) of cell size and coefficient of variation (CV) of cell area were all significantly higher in diabetics. Hexagonality was significantly lower in diabetics (41.1%±19.6%) compared to non-diabetics (45.2%±20.6%). CCT was higher in diabetics but not significant (P>0.05). Duration of diabetes, HbA1c level and severity of diabetic retinopathy were not significantly correlated with corneal endothelial findings.

CONCLUSION

Type II diabetes causes a significant alteration in the state of the cornea including reduction in endothelial cell density and increased pleomorphism and polymegathism. Central corneal thickness is unaffected.

Plant metabolites: an alternative and sustainable approach towards post harvest pest management in pulses

Grain legumes are an important source of proteins in vegetarian diet besides their role in biological nitrogen fixation. They are prone to heavy pest infestation both on and off the field. Pest associated losses are an important contributing factor towards declining per capita availability of grain legumes. Synthetic chemical pesticides have played an important role in crop preservation, however their incessant use has posed several environmental and human health concerns. Methyl bromide and phosphine are commonly used for the post harvest preservation of grain legumes. However, the former has to be phased out by 2015 as per the Montreal protocol whereas the latter is showing development of resistance to it by the insects. In the light of this, alternative, safer and sustainable strategies are needed for crop protection. Plants can serve as a rich source of bioactive chemicals for this purpose. Both primary as well as secondary metabolites can be evaluated against the target pests. The paper reviews the status of research in the area of use of plant metabolites in post harvest pest management of grain legumes.

Socioeconomic background in relation to stage at diagnosis, treatment and survival in women with breast cancer

In a large population-based series of invasive breast cancer patients, we investigated socioeconomic background (SEB) in relation to (a) stage at diagnosis; (b) treatment pattern; and (c) 5-year survival. Women diagnosed during 1998–2000 and resident in the Northern and Yorkshire regions of England were identified from the cancer registry database (N=12 768). Logistic regression and Cox proportional hazards analyses were used to estimate associations between SEB (defined using the Townsend Index for area of residence) and tumour stage, treatment pattern, and survival. Living in a more deprived area was associated with increased likelihood of being diagnosed with stage III or IV disease (age-adjusted odds ratio (OR) 1.13; 95% confidence interval (CI) 1.08–1.18 per quartile increase in Townsend score), and, after adjustment for age and stage, reduced odds of having surgery (OR 0.85; 95% CI 0.80–0.91), and receiving radiotherapy (OR 0.91; 95% CI 0.88–0.94). Amongst patients receiving surgery, those living in more deprived areas had decreased odds of having breast conserving surgery (age plus stage-adjusted OR 0.92; 95% CI 0.89–0.95). Living in a more deprived area was also associated with increased mortality (age- plus stage-adjusted hazard ratio 1.08; 95% CI 1.05–1.11). These effects may operate through several pathways, such as later presentation leading to advanced disease.

Bilateral corneal perforation in a sexually active adult male with gonococcal conjunctivitis

A 41 year-old Malay man had been treated by general practitioners for bilateral red eyes with profuse discharge of three weeks' duration with no improvement. He then presented to an ophthalmologist who noted profuse purulent discharge, bilateral corneal perforation, lid swelling and chemosis. Culture of the ocular discharge grew Neisseria gonorrhoeae. Treatment with systemic and topical antibiotics prevented microperforations in the right eye from progressing to overt perforation and was able to control disease in the left eye.

Prevalence of blindness and cataract surgery in Gandaki Zone, Nepal

BACKGROUND/AIM

Himalaya Eye Hospital (HEH), established in 1993, is rendering eye care services in the Gandaki and Dhaulagiri zones. The hospital has extensive community outreach activities along with services for outpatients, emergencies, and subspecialties such as vitreoretinal, paediatric, and low vision. The operation theatre is well equipped to match the surgical needs including phaco surgery for cataract. The hospital has performed more than 14 000 cataract surgeries and 250 000 treatment services during this period. The aim of this study was to estimate the prevalence of blindness, visual impairment, and cataract surgical coverage among the older adult population of three districts of Gandaki Zone, where 80% of the hospital's service recipients reside.

METHODS

People aged 45 years and older were enrolled in the study using a stratified cluster design. Subjects in 25 randomly selected clusters from the listed 806 were recruited through door to door visits. Each recruited subject had visual acuity (VA) and clinical examination conducted by an ophthalmologist. The survey was preceded by pre-pilot and pilot studies to refine the operational method. To assess quality assurance the interobserver variation in VA measurement was also carried out in five different clusters.

RESULTS

Out of 5863 selected subjects 85.3% were examined. Blindness defined as presenting VA <6/60 in both eyes was found in 2.6% (95% confidence interval (CI): 2.2 to 3.9), whereas 16.8% individuals examined had vision <6/19 in one or both eyes. Cataract was the principal cause of blindness in 60.5%, and refractive error was the dominant cause of vision impairment (<6/19) 83.3%. Cataract surgical coverage was 59.5% among the cataract blind and associated with younger age, literacy, and male sex.

CONCLUSION

The finding suggests a positive impact of the HEH programme on the prevalence of blindness and cataract surgical services in the survey area. Strategies to further improve access and utilisation of facilities and increase cataract surgical coverage need to be developed.

Postoperative seizures after extratemporal resections and hemispherectomy in pediatric epilepsy

Objectives: To estimate frequency and risk factors for acute postoperative seizures (APOS) within the first week after extratemporal cortical resection (ETR) and hemispherectomy (HS) in children and to assess the predictive value of APOS on long-term seizure outcome in this group.

Methods: The authors conducted a retrospective analysis of children (<18 years), who underwent ETR or HS for intractable epilepsy between 1995 and 2002. APOS features and seizure outcome after ETR or HS were obtained at 6, 12, and 24 months. Univariate logistic regression was used for risk factors of APOS and life table analysis and log rank tests for seizure outcome at 0 to 6, 6 to 12, and 12 to 24 months.

Results: Of 132 patients, 34 (26%) had APOS. APOS were more frequent after ETR (26/71) than HS (8/61) (p < 0.01). APOS, irrespective of their timing, number, semiology, or other perioperative complications, were an independent predictor of poor postoperative seizure outcome at 2 years (p < 0.001). The estimated odds of postoperative Engel class I outcome in the APOS vs non-APOS categories was 0.27 (73% less likely) for 0- to 6-month, 0.22 (78% less likely) for 6- to 12-month, and 0.13 (87% less likely) for the 12- to 24-month intervals.

Conclusions: Acute postoperative seizures (APOS) occur in 26% children, and the risk is higher after extratemporal cortical resection than hemispherectomy. APOS predict a poor postoperative seizure outcome at 6, 12, and 24 months. This study is useful for counseling families after epilepsy surgery. It also suggests that APOS may not be discounted as “benign” in research studies that evaluate seizure outcomes after epilepsy surgery.

Changes in astigmatism in children with congenital nystagmus

BACKGROUND

Astigmatism is commonly reported in children with and without nystagmus. In children less than 4 years of age the astigmatism changes from against the rule (ATR) to with the rule (WTR) astigmatism in children without nystagmus. However, little is known about children with congenital nystagmus. We compared astigmatism in children with congenital nystagmus below 4 years and above 4 years of age.

MATERIAL AND METHODS

Three hundred and fifty-six eyes in 178 children who satisfied the study criteria were included. The children were divided into those below 4 years of age (n of eyes = 192) and those above (n of eyes = 164). Cycloplegic refraction (with manual retinoscopy) carried out at presentation and at the last follow-up were recorded and compared. Cycloplegia was achieved using cyclopentolate eye drops. Outcome of eyes with no astigmatism at initial presentation was compared with the final refraction in both the age groups. The visual acuity at the first presentation was compared with the visual acuity at the last presentation.

RESULTS

Average follow-up duration was 3.36+/-1.59 years. On presentation, 176 (49.44%) eyes did not have any astigmatism. We found that 26 (25.2%) out of the 103 children below 4 years of age who did not have any astigmatism on presentation developed WTR astigmatism after a mean follow-up of 3.5+/-1.5 years. (p= 0.042). In children >or=4 years of age only 7 (9.6%) children out of 73 developed WTR after a mean follow-up of 3.4+/-1.4 years. The visual acuity change was not found to be significant in the two groups. The majority (90.3%) improved or had same visual acuity in group A and 88.9% improved or had the same visual acuity in group B at the last follow-up (p= 0.77).

DISCUSSION

Our incidence of WTR astigmatism in children with congenital nystagmus is similar to those previously reported series. Our data suggest that there is a significant chance that children under 4 years with congenital nystagmus may develop WTR astigmatism compared with children above 4 years of age.

CONCLUSION

With the rule (WTR) astigmatism is common in children with nystagmus. Children under 4 years of age presenting with no astigmatism may acquire WTR astigmatism as they grow. The amount of astigmatism increases with age in children with nystagmus. Visual acuity, however, remains stable as the age advances.

Multidisciplinary approach in the long-term management of intrahepatic stones: Indian experience

BACKGROUND

Intrahepatic stones, though common in East Asia, are uncommon in India. There is paucity of data from India regarding the treatment and long-term outcome of patients with intrahepatic stones.

METHODS

We retrospectively analyzed medical records of 35 patients with intrahepatic stones who had been treated surgically. Endoscopic biliary drainage had been used in patients who presented with acute cholangitis. Intraoperative stone clearance was confirmed by choledochoscopy and intraoperative cholangiography. Outcome of surgery, frequency and subsequent management of recurrent intrahepatic stones, and factors associated with stone recurrence and cholangitis were analyzed.

RESULTS

Twenty-one (60%) patients had bilobar disease. Eight patients underwent hepatectomy and 16 hepatico-jejunostomy with access loop; 12 of these were jejuno-duodenal anastomoses. Postoperative morbidity was observed in 10 patients (29%). Recurrence of stones occurred in 12 patients (34%) and cholangitis in 9 patients (26%). Presence of bilobar disease and associated biliary strictures were associated with recurrent cholangitis (p< 0.05). Two patients (6%) required re-operation for recurrent cholangitis. Complete removal of recurrent stones using conventional endoscope was possible through jejuno-duodenostomy in all 5 cases who had this type of access loop construction.

CONCLUSION

Surgical treatment for intrahepatic stones depends on the site of involvement. Construction of a jejuno-duodenal access loop in patients with bilobar disease and intrahepatic strictures is helpful in facilitating postoperative stone clearance. A multidisciplinary approach is beneficial especially when the disease is bilobar and recurrent in type.

Are some cases of infected pancreatic necrosis treatable without intervention?

BACKGROUND

Infected pancreatic necrosis is considered an absolute indication for interventional management such as percutaneous drainage or surgery. The presence of retroperitoneal air is a sign of anaerobic sepsis.

METHOD

A retrospective review of case records of patients presenting with severe acute pancreatitis and pancreatic necrosis was performed to identify cases in whom conservative treatment was followed by a satisfactory outcome.

RESULTS

Four patients were identified over a 3-year period who had pancreatic necrosis and retroperitoneal air; they were treated with antibiotics and intensive care, and they improved without any interventional treatment.

CONCLUSIONS

Some patients with infected pancreatic necrosis are treatable medically. The clinical status of the patients may well be a more important factor governing the choice of the treatment approach than bacteriological findings of infection alone.

Port-site tuberculosis after laparoscopy: report of eight cases

In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments by immersion in 2% glutaraldehyde. This article describes the clinical features of eight patients who presented with biopsy-proven tuberculosis at the port-site unassociated with other clinical features of tuberculosis. Three of the eight patients had positive cultures for Mycobacterium tuberculosis. The port-site sinuses healed with antituberculous chemotherapy. There is conflicting information in the literature regarding the effectiveness of a 20-min instrument soak in 2% glutaraldehyde to clear M. tuberculosis. In light of the preceding information, the current practice of glutaraldehyde disinfection for reusable laparoscopes needs to be reexamined.

Laparoscopic cholecystectomy in acute cholecystitis

BACKGROUND

In the light of laparoscopic cholecystectomy increasingly applied to all forms of cholecystitis, this study aimed at evaluating the safety of laparoscopic cholecystectomy applied to all cases of acute cholecystitis, and at determining factors associated with the risk of conversion to open cholecystectomy.

METHODS

The clinical, biochemical, radiologic, and operative data from 124 consecutive cases of acute cholecystitis were analyzed retrospectively to determine the complications and morbidity after operation. The data were analyzed further by univariate and multivariate analysis to identify factors associated with conversion.

RESULTS

No major bile duct injury or mortality occurred. Bile leak from the stump of the cystic duct developed in four patients. These were managed successfully by endoscopic biliary stent placement. The mean duration of hospital stay was 3.8 days in the laparoscopic group and 8.2 days in the open group. Of the 124 patients (18.5%), 23 underwent conversion to open cholecystectomy. Univariate analysis identified the following factors as associated with conversion: common duct dilation greater than 7 mm observed on ultrasound, (p < 0.05), pericholecystic collection seen on ultrasound (p < 0.0001), emphysematous cholecystitis (p < 0.01), endoscopic retrograde cholangiopancreatographic evidence of Mirizzi syndrome (p < 0.05), and pericholecystic collection at operation (p < 0.0001). On multivariate analysis, only pericholecystic collection (p < 0.015) and gallbladder wall thickness greater than 5 mm (p < 0.013) were statistically significant.

CONCLUSIONS

Laparoscopic cholecystectomy for acute cholecystitis can be applied safely to all comers, offering the advantage of a shortened hospital stay. Pericholecystic collection, as observed on ultrasound, is associated with a high risk of conversion to open cholecystectomy.

Brunner's gland adenoma with circumferential duodenal involvement

Brunner's gland adenoma is a benign tumor of the duodenum. We report a 58-year-old man who presented with abdominal pain, vomiting and weight loss. The patient underwent Whipple resection along with lymph node clearance. The resected tumor, 4 cm long, showed hypertrophied Brunner's glands.

Primary tuberculous stricture of the oesophagus mimicking carcinoma

A middle-aged woman presented with progressive dysphagia and weight loss was investigated. A stricture involving the lower third of oesophagus was identified but precise histology of the lesion could not be obtained even after multiple biopsies. The resected specimen showed histology consistent with oesophageal tuberculosis.

Future molecular approaches to the diagnosis and treatment of glomerular disease

Current diagnoses and treatment decisions for renal disease are made based upon a combination of clinical and pathological determinations. With the advances in both biochemical and molecular biological techniques, identifying the underlying biochemical and genetic changes that may have initiated and/or contributed to the disease is possible. We describe here technologies that may lead to significant changes in renal disease diagnosis, characterization, treatment, and potentially prevention. For example, differential display techniques and DNA gene chip arrays show the changes in mRNA expression patterns and can potentially identify previously unknown genes and reveal new roles for previously known genes in renal disease. The generation of the single nucleotide polymorphisms (SNP) genomic map will facilitate genetic screening that may identify a gene or combination of genes that produce enhanced disease susceptibility. Combining genomic analysis with epidemiological studies may identify environmental factors that contribute to renal disease onset in genetically susceptible individuals. A number of novel therapies are already on the horizon. These include reagents that abrogate the function of specific cytokines, chemokines, and effector cells. With the list of renal disease genes in hand, their role in renal physiology and pathophysiology can be determined, which should lead to the discovery of pharmacological intervention directed at those genes and their products that play a role in the pathogenesis of renal disease.

8-anilino-1-naphthalene sulfonic acid (ANS) induces folding of acid unfolded cytochrome c to molten globule state as a result of electrostatic interactions

Hydrophobic interaction of 8-anilino-1-naphthalene sulfonic acid (ANS) with proteins is one of the widely used methods for characterizing/detecting partially folded states of proteins. We have carried out a systematic investigation on the effect of ANS, a charged hydrophobic fluorescent dye, on structural properties of acid-unfolded horse heart cytochrome c at pH 2.0 by a combination of optical methods and electrospray ionization mass spectroscopy (ESI MS). ANS was found to induce, a secondary structure similar to native protein and quenching of fluorescence of tryptophan residue, in the acid-unfolded protein. However, the tertiary structure was found to be disrupted thus indicating that ANS stabilizes a molten globule state in acid-unfolded protein. To understand the mechanism of ANS-induced folding of acid-unfolded cytochrome c, comparative ESI MS, soret absorption, and tryptophan fluorescence studies using nile red, a neutral hydrophobic dye, and ANS were carried out. These studies suggested that, at low pH, electrostatic interactions between negatively charged ANS molecules and positively charged amino acid residues present in acid-unfolded cytochrome c are probably responsible for ANS-induced folding of acid-unfolded protein to partially folded compact state or molten globule state. This is the first experimental demonstration of ANS induced folding of unfolded protein and puts to question the usefulness of ANS for characterization/determination of partially folded intermediates of proteins observed under low pH conditions.

The effect of tibiotalar fixation on foot biomechanics

Contact areas and peak pressures in the posterior facet of the subtalar and the talonavicular joints were measured in cadaver lower limbs for both the normal limb and after fixation of the tibiotalar joint. Six joints were fixed in neutral, in 5-7 degrees of varus and of valgus. Ten degrees of equinus angulation was also studied. Each position of fixation was tested independently. Neutral was defined as fixation without coronal or sagittal plane angulation compared with prefixation alignment of the specimen. When compared with normal unfused condition, peak pressures increased, and contact areas decreased in the subtalar joint for specimens fixed in neutral, varus, and valgus. However, the change in peak pressure for neutral fusion compared with normal control was not statistically significant (P > 0.07). Peak pressures for varus and valgus fixation were significantly different from normal (P < 0.001). Contact areas for all positions of fixation were significantly different from normal (P < 0.001). Coronal plane angulation, however, also resulted in significantly lower contact areas compared with neutral fixation (P < 0.001). Contact areas and peak pressures in the talonavicular joint did not appear to be substantially affected by tibiotalar fixation with coronal plane angulation. Equinus fixation qualitatively increased contact areas and peak pressures in the talonavicular and posterior facet of the subtalar joint. Neutral alignment of the tibiotalar joint in the coronal and sagittal planes altered subtalar and talonavicular joint contact characteristics the least compared with normal controls. Therefore, ankle fusion in the neutral position would be expected to most closely preserve normal joint biomechanics and may limit the progression of degenerative arthrosis of the subtalar joint.

Neonatal nosocomial infection: profile and risk factors

OBJECTIVE

To determine the incidence and risk factors for neonatal nosocomial infections.

DESIGN

Cohort study.

SETTING

Tertiary care Teaching Hospital.

METHODS

Hospital born neonates transferred to the neonatal unit after birth and available in the unit 48 hours later comprised the cohort for the surveillance. Detailed maternal, intrapartum and neonatal variables were recorded. Risk factors for nosocomial infection were analyzed by both univariate and multiple logistic regression methods.

RESULTS

One hundred and thirty-four neonates were enrolled in the cohort. The overall nosocomial infection rate was 16.8/1000 patient days. Device associated infection rate was 11.9/1000 device days. Multidrug resistant Klebsiella species was the commonest organism causing nosocomial septicemia and pneumonia followed by Pseudomonas aeruginosa. The risk factors detected to be significantly associated with infection on multiple logistic regression analyses were a birth weight < 1500 g (OR 3.3) and assisted ventilation > 72 h (OR 14.2).

CONCLUSIONS

Very low birth weight (VLBW) neonates, especially those undergoing interventions such as mechanical ventilation are at the greatest risk for infection and death. Therefore, strict protocol for asepsis must be adhered to when handling these high risk infants.

Type-specific antibodies to purified streptococcal M proteins from potentially rheumatogenic M-types in patients with rheumatic fever and rheumatic heart disease

This study was designed to identify the predominant serotypes of group A streptococci (GAS) responsible for rheumatic fever (RF) and rheumatic heart disease (RHD) in India. RF and RHD sera were screened for antibodies to M proteins retrospectively against known rheumatogenic M types and M types isolated from patients with acute RF. All GAS strains isolated from four patients with acute RF in a short outbreak of RF, were identical - serum opacity factor (SOF) negative, T-pattern 3/13 B3264 and M-non-typable. Because of this, M protein was isolated from only one of these four M-non-typable strain (S-399). This was done by limited pepsin digestion and purification by ion-exchange chromatography on DEAE-Sephadex, followed by gel filtration. Purified M protein was found to be homologous on SDS-PAGE (mol.wt 20 kDa), immunogenic in rabbits and to retain its antigenic structure. This purified M protein from an M-non-typable strain (pep-MNT) was used as an antigen to screen RF and RHD sera retrospectively by ELISA for the prevalence of the M-non-typable GAS strain. The prevalence of the M-non-typable strain was compared with that of the known rheumatogenic M types. Results suggest that the M-non-typable strain could be a provisional new rheumatogenic M type in India and could be a candidate for a multivalent M-protein vaccine to control RF and RHD.

Detection of antibody to C-carbohydrate of group A streptococci with enzyme-treated whole bacterial cells as antigen for ELISA

Antibody to specific cell-wall carbohydrate of group A streptococci in human sera was determined by enzyme-linked immunosorbent assay (ELISA) with enzyme-treated whole cells and purified group A carbohydrate (ACHO) as antigens. The optimal concentration of enzyme-treated whole bacterial cells to coat wells was 2 x 10(8) cells/ml and for purified ACHO antigen the optimal concentration was 1 microgram/ml. Sera from patients with acute rheumatic fever and acute glomerulonephritis were screened for the presence of C-carbohydrate antibodies. Patients with acute post-streptococcal complications showed significantly higher titres of antibody when compared with normal healthy individuals. ELISA results were also compared with purified ACHO as an antigen; this showed a highly significant correlation (r = 0.73). Results showed that measurement of the anti-ACHO antibody by ELISA with enzyme-treated whole cells can be a useful, reliable and simple method for serological diagnosis of group A infection and sequelae.

Multiplex selection technique (MuST): an approach to clone transcription factor binding sites

We have used a multiplex selection approach to construct a library of DNA-protein interaction sites recognized by many of the DNA-binding proteins present in a cell type. An estimated minimum of two-thirds of the binding sites present in a library prepared from activated Jurkat T cells represent authentic transcription factor binding sites. We used the library for isolation of "optimal" binding site probes that facilitated cloning of a factor and to identify binding activities induced within 2 hr of activation of Jurkat cells. Since a large fraction of the oligonucleotides obtained appear to represent "optimal" binding sites for sequence-specific DNA-binding proteins, it is feasible to construct a catalog of consensus binding sites for DNA-binding proteins in a given cell type. Qualitative and quantitative comparisons of the catalogs of binding site sequences from various cell types could provide valuable insights into the process of differentiation acting at the level of transcriptional control.

Imaging in phaeohyphomycosis of the brain: case report

A case of multiple, conglomerated brain abscesses due to Xylohypha bantiana, with unique imaging features, is presented. This is the first culture-proven case of brain infection due to this fungus in the neuroimaging literature.