Use of Magnetic Resonance Imaging in the Evaluation ofAcute Cholecystitis in Emergency Setting

Background Acute cholecystitis is one of the commonest surgical disease. The rapid diagnosis at its early stage is one of the crucial factor in patient care and management. Objective To evaluate the role of magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis or exclusion of acute cholecystitis, coexisting choledocholithiasis, and acute pancreatitis in emergency setting. Method This study was conducted in the department of radiodiagnosis B and C teaching hospital, Birtamod, Nepal from July 2016 to November 2019. Patients, clinically diagnosed as acute cholecystitis or biliary condition with positive Murphy's sign with or without jaundice and deranged Liver Function Test, raised Leucocyte counts were evaluated by Magnetic Resonance imaging. The sensitivity, specificity, Positive Productive Value (PPV), Negative Productive Value (NPV) were calculated for the diagnosis of acute cholecystitis. Data was entered and analysed by using SPSS version 20. Result There were 40 patients included in our study. Among them 27 (67.5%) were females and 13 (32.5%) male. The age of the patients ranged from 16 years to 79 years, mean age 49.4 years. Majority of the patients were in the age group of 40-60 years (57.5%). The overall sensitivity, specificity, Positive Productive Value and Negative Productive Value of Magnetic Resonance imaging diagnosis of acute cholecystitis were 100%, 66.6%, 94.4% and 100% respectively. Acute cholecystitis associated with gall stone disease were common and found in 72.5% cases, with sensitivity 96.5%, specificity 27.7%, Positive Productive Value 77.7% and Negative Productive Value 75.0%. Conclusion Magnetic resonance imaging (MRI)/Magnetic resonance cholangiopancreatography (MRCP) is an excellent tool for the evaluation of biliary pathology and can be used for the preoperative evaluation of acute cholecystitis at the emergency setting.

Plasma cell rich acute rejection: Risk factors, treatment and outcomes

Plasma cell-rich rejection is a rare and poorly defined entity. Its treatment is not clearly defined and has universally poor prognosis. More data should be published from various transplant centers around the world to identify the treatment that has the best outcomes and to formulate treatment guidelines for these cases. It is a retrospective analysis of kidney biopsies form 2008 to 2018. Four hundred biopsied were screened and 55 were found to have features of rejection and among them, 13 had plasma cell-rich rejection. Data of treatment given and the graft survival outcomes in these cases were retrieved by medical records. One patient had complete recovery, three had graft loss and the remaining nine had permanent decline in glomerular filtration rate. Decrease in immunosuppression and presence of infection are risk factors for plasma cell-rich acute rejection (PCAR). It can be acute cell-mediated rejection (ACR)/antibody-mediated rejection (AMR)/ACR+AMR. Resistant rejection, ACR+AMR, C4d positivity, and severe interstitial inflammation are poor prognostic factors. Overzealous decrease in immunosuppression should not be done. Management of immunosuppression during infection is most critical for the development of PCAR. Bortezomib is emerging as a therapeutic modality for the treatment of PCAR.

Magnetic Resonance Imaging Evaluation of Musculoskeletal Diseases of Ankle and Foot

Background Ankle and foot pain is a common clinical problem, that may be due to a variety of soft tissue and osseus abnormalities. Magnetic resonance imaging plays vital role for diagnosing internal derangement of the ankle joint, assessing soft tissue structures around the ankle such as tendons, ligaments, nerves and osseus structures. Method Retrospective magnetic resonance imaging evaluation of the ankle and foot was done in 100 patients using 0.3T and 1.5T magnetic resonance imaging. Clinical history included pain, swelling of the ankle and foot, trauma, twisting injury, palpable mass and difficulty in walking. Result Fifty two patients were male and 48 patients female aged 6 months to 70 years. Ligaments tear were the commonest and seen in 22% patients. Tenosynovitis found in 17%, Pigmented villonodular synovitis (PVNS) in 3%, Achilles tendon abnormality in 8%, stress fracture-9%, osteomyelitis-8%, soft tissue vascular malformation in 5%, soft tissue and bone tumor-4%, marrow edema-20%, osteoarthritis-10%, Osteochondral lesion of talus-8%, sinus tarsi syndrome-3%, posterior impingement-5%, plantar fasciitis-2%, Sever disease-2%, peroneus tendon split-2%. The commonest clinical presentation was pain and swelling of the ankle in 42 patients, twisting/inversion injury of the ankle in 23 patients followed by traumatic injury with difficulty in walking in 20 patients and palpable mass in 8 patients. Ligaments injury were mostly associated with inversion/twisting injury. Conclusion Magnetic resonance imaging is advantageous for assessing soft tissue structures around the ankle and foot, such as tendons, ligaments, nerves, masses and occult osseus lesions. It provides a quick, non-invasive tool for the diagnosis of related injuries and guide for the further treatment planning.

Pharmacological activities of cinnamaldehyde and eugenol: antioxidant, cytotoxic and anti-leishmanial studies

The present study reports the antioxidant, cytotoxic and anti-leishmanial activities of cinnamaldehyde and eugenol. Both the compounds are naturally present in cinnamon and bay leaf. Eugenol is abundantly present in clove. The antioxidant potential was measured in terms of reducing power (FRAP assay), nitric oxide (NO) radical scavenging ability and anti-lipid peroxidative activities. MTT assay was used to evaluate the effect of test compounds on cell viability of prostate cancer cell line (PC-3) as well as for the assessment of in vitro growth inhibition of promastigotes as a measure of anti-leishmanial activity.  Eugenol exhibited considerable NO radical scavenging (63%) and reducing abilities (FRAP value 127×104 µM/mM) while cinnamaldehyde showed comparatively better protective efficacy against lipid peroxidation in rat brain and kidney homogenates (up to 40%). Cinnamaldehyde also displayed substantial cytotoxic activity (75%) against PC-3 cell line. Both the compounds exhibited moderate anti-leishmanial activity and IC50 values for eugenol and cinnamaldehyde were found to be 0.681 g/ml and 1.426g/ml, respectively. The study revealed that both the test compounds have noticeable antioxidant and cytotoxic activities.

Patterns of scrotal pain in a hospital setting

Introduction: Scrotal pain is a common urological condition. Common causes of scrotal pain are testicular torsion, epididymitis, epididymo-orchitis and occasionally due to post vasectomy pain, varicocele, testicular trauma etc. The objective of our study is to review the different disease patterns in patients presenting with scrotal pain in a tertiary care hospital.Methods: Patients presenting with scrotal pain to the out-patient clinic and the emergency department were included in the study. All patients were subjected to urinalysis and ultrasound of scrotum with color Doppler study when needed. Descriptive variables were studied and analyzed.Results: Eighty three patients were enrolled in the study during the period of one year. Age ranged from 13 to 72 years; most of the patients were less than 40 years and more than 20 years. Among this age group non-specific orchalgia was very common. Isolated epididymitis was seen in only 4 (4.81%) patients. Epididymo-orchitis was found in 16 (19.27%) patients. Torsion of testis was found in 6 patients (7.22%). The major bulk of the patients presenting with scrotal pain were nonspecific which was found in 39 (46.98%) and exact cause could not be found in them. Total of 15 (18%) patients had acute presentation.Conclusion: Management of Scrotal pain can be simple or at times organ threatening, proper diagnosis and treatment by clinical judgment and necessary investigation is very important.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 31-34

Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital

Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population.

Efficacy of Tamsulosin in relieving double-J stent-related symptoms: a randomized controlled study

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice.They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life, and can be applied in routine clinical practice. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied.Methods: This RCT was carried out in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin(T) group and Control(C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4mg Tamsulosin daily and Paraceramol on demand and control group received only Paracetamol. Stent related symptoms and quality of life was assessed by IPSS at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by VAS and analgesic requirement was documented. Data were analysed using SPSS 20, chi-square test and Student’s t- test was used. A p-value of <0.05 was considered significant.Results: Mean age in Tamsulosin group was 37.96±12.98 and Control group 36.43± 10.99(p=0.67).There was no significant difference in IPSS(p=0.141), QoL index (p=0.089) and VAS (p=0.59) in the two groups at the time of discharge.At the time of DJ stent removal, IPSS (p<0.001), QoL index (p<0.001), VAS (p=0.004) and analgesic needed (p<0.001) was significantly lower in T group than in C group.Conclusion: Tamsulosin lowers stent related symptoms, pain and improves quality of life in patients with indwelling DJ stent though the effect is not immediate.

Adrenal histoplasmosis : a rare cause of bilateral adrenomegaly

Histoplasmosis is an opportunistic infection caused by a dimorphic fungus Histoplasma capsulatum. Histoplasmosis causing bilateral adrenal involvement is rare and usually occurs only in immunocompromised individuals with disseminated disease.  Here we report a case of bilateral adrenal histoplasmosis with disseminated disease in an immunocompetent patient.

Change in storage symptoms after transurethral resection of prostate: a prospective observational study

Introduction: Patients with enlarged prostate generally rate their storage symptoms (frequency, urgency and nocturia) as the most bothersome as these symptoms interfere more with daily activities and have huge impact on quality of life. Effect of transurethral resection of prostate (TURP) on storage symptoms is unknown. Objective of the study is to assess the change in storage symptoms in patients undergoing TURP.Methods: A prospective observational study was conducted at the author’s institute from August 2011 to July 2012. Patients undergoing TURP for moderate to severe lower urinary tract symptoms (LUTS) secondary to benign enlargement of prostate were included. Patients were evaluated by International prostate symptom score (IPSS) questionnaires. The question number 2, 4 and 7 of the IPSS questionnaire gave the storage symptom subscore (0-15). After initial evaluations, the patients underwent TURP. After 3 months, the IPSS was reevaluated and the change in storage symptom was analyzed.Results: A total of 57 patients who had undergone TURP were eligible for final data analysis. Majority of the patients had severe bothersome LUTS with mean IPSS score of 24.6±6. The baseline storage symptom subscore was 11.1±3. After 3 months of follow-up, there was significant decrease in total IPSS score and both of its subscores. On comparing the mean change in storage and voiding subscore, there was less decrement in storage subscore which was statistically significant (p=0.001). Conclusions: This study showed that after TURP change in voiding subscore occurs more than storage subscore and storage symptoms may not revert to normal.

Clinicopathological Pattern of Penile Cancer in a Tertiary Care Centre in Nepal

INTRODUCTION

Carcinoma of penis is an uncommon entity. The higher incidence in developing country may be because of poor hygiene, less common practice of circumcision and unsafe sexual practice. Timely diagnosis and intervention gives the patient a chance of cure. Data on penile cancer is sparse from Nepal so treatment of penile cancer in our centre is presented here.

METHODS

This was a retrospective cross-sectional study done at Urology unit of Department of Surgery of Tribhuvan University Teaching Hospital, Nepal from November, 2007 to December, 2013. Data was retrieved from case records and those with penile carcinoma were included. Patient demographics, lesion characteristics, mode of treatment with outcome measures were noted and analyzed.

RESULTS

Total 17 patients underwent treatment for primary penile lesion. Mean age of the patients was 51.5 years. Penile growth was the most frequent presentation with five patients coming with more than one symptom. The most common site was over glans of penis (n=13) with the mean size of 3.55 cm. Partial penectomy was offered in 16 with one patient undergoing circumcision only. Inguinal lymph node dissection was done in four patients. Squamous cell carcinoma was the histological diagnosis in 15 patients.

CONCLUSIONS

Penile carcinoma is primarily a disease of old. Growth over glans penis is the most common presentation and partial penectomy is feasible in most of the patients to allow oncological cure while preserving the organ for its native function.

Cervical capillary haemangioma: a case report

Capillary haemangioma is a common benign lesion occurring at multiple areas of body. They have unique radiological appearances and are confirmed by histological examinations. However capillary haemangioma of cervical region is a very rare condition. Such a case is presented here. It presented as an extramedullary intradural mass compressing the cord and corresponding root giving rise to myeloradiculopathic symptoms. Total enblock excision of the lesion gave a total cure.

Nephron sparing surgery in a tertiary care center in Nepal--an initial experience

BACKGROUND

Malignant renal mass accounts for 2 to 3% of all malignant diseases in adults. Radical surgery used to be the treatment of choice with high propensity to develop chronic kidney disease in the compromised contralateral kidney. Currently, nephron sparing surgery is considered to be the standard of care with equivalent oncological outcome.

METHODS

This was a retrospective chart review of patients with renal mass less than seven cm in size who had open nephron sparing surgery from July 2012 to Sep 2013 at Tribhuvan university teaching hospital, Nepal. Latest follow up either from record or over telephone was documented.

RESULTS

Eight patients (mean age 45 years, male: female ratio1:1.6) underwent nephron sparing surgery over the specified period. Mean size of tumor was 4.75 cm. Mean ischemia time was 16.37 min. Histopathological diagnosis was benign in two and renal cell carcinoma in six patients.

CONCLUSIONS

Nephron sparing surgery is safe in low stage renal tumors. It also prevents unnecessary nephrectomy in benign lesions and prevents negative sequelae of long term chronic renal impairment in remaining contralateral kidney.

Phaeochromocytoma in Nepal--a single centre experience

BACKGROUND

Phaeochromocytomas are rare tumors of chromaffin cells of neural crest that classically present with symptoms of catecholamine excess such as palpitations, headache and sweating. They are diagnosed by measuring plasma or urinary levels of catecholamines or their metabolites. Anatomic localization is done by computed tomographic scan or magnetic resonance imaging, or meta-iodobenzyl guanidine scan in certain cases. Adequate preoperative catecholamine blockade prevents perioperative hemodynamic instability.

OBJECTIVES

To study the clinical spectrum and management of phaeochromocytomas in a tertiary care centre, Tribhuvan University Teaching Hospital, in Nepal.

METHODS

Retrospective review of case records of histologically proven cases of phaeochromocytomas from 2008 -2011 was done, and data collected on clinical spectrum, diagnostic modalities, perioperative management and follow-up.

RESULTS

Twelve cases of phaeochromocytomas were operated. The mean age was 36.41+/-14.07 years. There were 2 bilateral phaeochromocytomas and 1 extraadrenal paraganglioma. Apart from the common symptoms of catecholamine excess, patients had atypical presentations like psychiatric manifestations and blurred vision. A combination of urinary Vanillyl Mandelic Acid and computed tomographic scan was used for diagnosis, and open surgery was done in all cases. Pre-operative blood pressure control was achieved by prazocin or calcium channel blockers. Ten patients had intraoperative surge in blood pressure. There were no major morbidity or mortality. Three patients had high blood pressure postoperatively, but were effectively managed with antihypertensives.

CONCLUSION

Phaeochromocytomas can have variable presentation. Good preoperative preparation and perioperative management can result in an excellent outcome.

Serum cystatin C as a marker of renal function in detection of early acute kidney injury

In patients with acute kidney injury (AKI), serum creatinine level does not increase until moderate to severe reduction in glomerular filtration rate (GFR) occurs. Thus its use for estimating GFR in early AKI delays detection of kidney damage and making important therapeutic decisions. Moreover, serum cystatin C is not affected by gender, age, race, and muscle mass and also does not suffer from lag period for its rise in early AKI. We studied 200 healthy subjects and 130 AKI patients over a period of 2 years at a tertiary care hospital. Serum creatinine and serum cystatin C were studied and analyzed in relevance to early AKI. We found that 56.2% of patients of AKI group had normal levels of serum creatinine in early phase, while all patients had elevated serum cystatin C at same time. Multiple logistic regression analysis revealed cystatin C-based GFR reflecting decline in GFR with worsening AKI in better than creatinine-based GFR. Serum cystatin C is a better marker of renal function in early stages of AKI and is less affected by age, gender, muscle mass, and ethnicity. Its use helps in early therapeutic intervention and possibly favorable outcome.

Protective efficacy of Solanum xanthocarpum root extracts against free radical damage: phytochemical analysis and antioxidant effect

Free radicals have been implicated in many diseases. They attack biological macromolecules in healthy human cells and cause protein and DNA damage along with lipid peroxidation. Present study reports the phytochemical analysis as well as free radical scavenging and antioxidant activities of Solanum xanthocarpum root extracts. Tannins, flavonoids, terpenoids, alkaloids, saponins and steroids were present in different extracts. Total flavonoid content in extracts was quantified and maximum contents were found in ethyl acetate fraction followed by chloroform and ethyl alcohol fractions, respectively. Dose dependent response was observed in metal ion chelating activity of extracts. Comparatively better chelating activity was found in polar extracts. Most of the extracts exhibited significant free radical scavenging activity in DPPH radical scavenging assay. Ethanolic and aqueous extracts accounted for about 40&mdash;50% lipid peroxidation inhibition (LPOI) in rat liver homogenate. Antioxidant activity did not show direct correlation with the amount of flavonoid contents in the extracts. However, direct correlation was observed between DPPH free radical scavenging activity and LPOI. Antioxidant activity of the extracts was compared with standard antioxidants. The differential activity observed in extracts could be attributed to the presence of other phytochemicals such as tannins and terpenoids in addition to flavonoids. The study demonstrated appreciable protective efficacy in S. xanthocarpum root extracts against free radical damage.

Clinical, MRI and arthroscopic correlation in internal derangement of knee

BACKGROUND

The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy.

OBJECTIVE

The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee.

METHODS

Forty one patients with suspected internal derangement of the knee were subjected to MR examination followed by arthroscopy. Clinical criteria used were history, mode of injury, Mc Murray, Apley grinding, Thessaly test for meniscal injury. Drawer test was considered to be essential for clinical diagnosis of cruciate ligament injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom C, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee.

RESULTS

The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%, 33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1% respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and 92.6% respectively for lateral meniscal tear.

CONCLUSION

Clinical examination showed higher sensitivity for medial meniscal tear compared to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage, synovial thickening.

Medico-religiousplantsusedbytheHajongcommunityofAssam,India

ETHNOPHARMACOLOGICAL RELEVANCE

The Hajong people use many medicinal plants in their different rituals. The information generated from the present study regarding the medico-religious plants used by the Hajong tribes need a thorough phytochemical investigation. This could help in creating awareness regarding the need for conservation of such plants and also in the promotion of ethno-medico-botany knowledge within the region besides contributing to the preservation and enrich- ment of the gene bank of such economically important species before they are lost forever. Medico-religious plants so found out in this study should be screened for their efficacy by which new drugs or products could be brought out. There is also need to document this information and compare with that of other tribes in the state and region.

MATERIALS AND METHODS

The diseases found during the research work among the Hajong community were grouped in 11 categories. The category of diseases includes plants used for both human and animal diseases. The informants having good knowledge on medico-religious plants were chosen for the interview. Kabiraj or Vaidyas were also included among the informants though they were not available in all villages. The informants were asked about the ritual and religious importance and the medicinal properties of the plants used in different cultural practices.

RESULTS

Some 36 plant species including herbs, shrubs and trees are used for curing 51 different diseases with 63 formulations which are recorded during the study. Most of the medicinal plants were collected from their own homestead and rest from the forest. Hajongs make sustainable use of available natural resources that include both medicinal and religious plants. They lead a much disciplined life. They are very much religious and knowledgeable. The survey revealed that not only the Kabiraj but also the elder community member have good knowledge of the medicinal value of some plant usually those species used to treat common diseases like cough, cold, fever, viral fever, headache, stomachache, joint pain, diarrhea, dysentery, minor wounds and cuts etc. Thus 36 plants are found to be used by Hajong in different medico-religious practices. These are regarded as holy plants. These plants are strictly protected by the community. Traditional conservation and management on cultural grounds, therefore, represents a historic contribution to the present day rich biodiversity in the region.

CONCLUSION

The whole life system and socio-economic as well as religious and cultural activities of Hajongs were totally dependent upon forests. It reflected their high possession of knowledge on medico religious plants which allowed them to apply their indigenous knowledge regarding various aspects of exploitation of such resources. Different types of important species have been disappeared from the study area, which ultimately creates social, economical and religious problem in Hajong community. The information generated from the present study regarding the medico-religious plants used by the Hajong tribes need a thorough phytochemical investigation. This could help in creating awareness regarding the need for conservation of such plants and also in the promotion of ethno-medico-botany knowledge within the region besides contributing to the preservation and enrichment of the gene bank of such economically important species before they are lost forever. Traditional culture in different Hajong populated areas is very fast declining with lot of traditional knowledge under the influence of dominant culture. Cultural diversity conservation is needed urgently.

Intracranial MR Venography Using L ow-Field Magnet: Normal Anatomy and Variations in Nepalese Population

Introduction: Magnetic resonance (MR) venography is considered a reliable imaging modality for the evaluation of intracranial venous system. The purpose of this study was to evaluate the normal venous anatomy and its variations in Nepalese population using low fi eld MR technique.  Methods: One hundred patients with normal MR imaging of brain underwent MR venographic study. MR venograms were performed in 0.35 T MR scanner using a contiguous 2D time-of–fl ight MR angiographic technique.  Results: The fl ow gaps in the transverse sinus were seen in 47% of population, of which 91% occurred in the non-dominant side. Right transverse sinus was dominant in 73% population. Flow gap was observed in bilateral transverse sinus in one case, while it was seen in the dominant right transverse sinus in 6.3% population. Inferior sagittal sinus was observed in 11% cases. Internal cerebral vein was seen in 60 cases. Occipital sinus was observed in 4% of the cases. The basal vein of Rosenthal was observed in 34% of the cases, whereas vein of Labbe seen in 8% cases. Unilateralfl ow gap in the sigmoid sinus was seen in 5 cases.  Conclusions: MR angiography done at low fi eld MR unit is a reliable tool in cerebral venous sinus assessment, particularly major dural sinuses. The fl ow gaps in transverse sinus are frequently encountered anatomic variation. Visualization of small veins like inferior sagittal sinus, basal vein of Rosenthal, vein of Labbe, internal cerebral vein was inferior in our study compared to other studies done in high fi eld MR unit.  Keywords: Dural sinus, intracranial veins, MR venography.

Intracranial MR venography using low-field magnet: normal anatomy and variations in Nepalese population

INTRODUCTION

Magnetic resonance (MR) venography is considered a reliable imaging modality for the evaluation of intracranial venous system. The purpose of this study was to evaluate the normal venous anatomy and its variations in Nepalese population using low field MR technique.

METHODS

One hundred patients with normal MR imaging of brain underwent MR venographic study. MR venograms were performed in 0.35 T MR scanner using a contiguous 2D time-of-flight MR angiographic technique.

RESULTS

The flow gaps in the transverse sinus were seen in 47% of population, of which 91% occurred in the non-dominant side. Right transverse sinus was dominant in 73% population. Flow gap was observed in bilateral transverse sinus in one case, while it was seen in the dominant right transverse sinus in 6.3% population. Inferior sagittal sinus was observed in 11% cases. Internal cerebral vein was seen in 60 cases. Occipital sinus was observed in 4% of the cases. The basal vein of Rosenthal was observed in 34% of the cases, whereas vein of Labbe seen in 8% cases. Unilateralflow gap in the sigmoid sinus was seen in 5 cases.

CONCLUSIONS

MR angiography done at low field MR unit is a reliable tool in cerebral venous sinus assessment, particularly major dural sinuses. The flow gaps in transverse sinus are frequently encountered anatomic variation. Visualization of small veins like inferior sagittal sinus, basal vein of Rosenthal, vein of Labbe, internal cerebral vein was inferior in our study compared to other studies done in high field MR unit.

Primary mucinous adenocarcinoma of the renal pelvis and ureter

Mucinous adenocarcinomas of the renal pelvis and ureter are among the rarest upper urinary tract neoplasm. We report a case of multifocal primary mucinous adenocarcinoma of the renal pelvis and ureter occurring in association with a staghorn calculus and pyonephrosis. A 68 year old man had suffered from right flank pain and upper abdominal swelling for one year. After a series of investigation, a right staghorn stone with pyonephrosis leading to non-functioning kidney was found. Right nephrectomy was performed. The pathological report showed mucinous adenocarcinoma with ureteric margin positive for tumour deposits. Patient was reoperated; right ureterectomy with removal of bladder cuff was done. Although uncommon, the possibility of a tumor should be kept in mind especially in patients with a long standing urolithiasis accompanied by hydronephrosis and/or infection.

Pattern of renal cell carcinoma - a single center experience in Nepal

BACKGROUND

Renal tumor is the 13th most common malignancy in the world and more than 90% of renal tumors are renal cell carcinomas. As there is no data available on renal cell carcinoma in Nepal, hence this study was undertaken to analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal.

OBJECTIVES

To analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal.

METHODS

The case records of 50 consecutive patients with renal cell carcinoma presenting at the Tribhuvan University Teaching Hospital, Kathmandu from July 2006 to June 2011 were retrospectively evaluated for presenting symptoms, physical finding, investigation and histopathology report.

RESULTS

Out of 50 patients, 64% were male and 36% were female. The age ranged between 11 to 78 years (mean ± SD: 55 ± 15 years). Fifty four percent of patients were smokers. Incidentally tumor was detected in 40% cases by ultrasonography and the typical triad was present in only 4%. The tumor was occupying upper pole in 40% of cases. The tumor size ranged from 3 to 15 cm (mean ± SD: 7.3 ± 2.9 cm). Histopathologically, 76% of the patient had organ confined renal cell carcinoma (T1- 2 N0 M0). Clear cell was the most common type seen in 86%. Fuhrman nuclear grade 2 was found in 50%.

CONCLUSION

Many of the renal cell carcinoma are detected incidentally, at an early stage and are of clear cell subtype.

Penile fracture at Tribhuvan University Teaching Hospital: a retrospective analysis

Fracture of the penis is rupture of the tunica albuginea and the usual cause is abrupt bending of the erect penis by blunt trauma. Trauma during sexual relation is responsible for approximately one third of all cases. The incidence of urethral injuries associated with this condition ranged from 2.0% to 38.0%. Twelve patients who presented to emergency over a period of 4 years with diagnosis of penile fracture were reviewed retrospectively. Patient's profile and all relevant data were noted from charts. The etiology of fracture was related to coital activity in 6 (50.0%) cases while other denied such act. Surgery was performed on all the patients and discharged from hospital on removal of urethral catheter. Follow up continued until restoration of normal penile function without complaint. So fracture of the penis is an injury that can be diagnosed clinically and needs emergency surgical correction for better result.

Renocolic fistula following percutaneous nephrostomy: a case report

Renocolic fistula is a rare clinical entity. In the past, its incidence was high due to infection, especially tuberculosis, and renal stone complications; which gradually reduced with advancements in antimicrobial therapy and better stone management. The incidence of renocolic fistulae, specifically iatrogenic one, has re-emerged due to minimally invasive renal surgery and regular percutaneous nephrostomy placement for various reasons. We reported a case of fifty-five-years-old gentleman who presented to emergency room with left lithiasic pyonephrosis for which percutaneous nephrostomy was placed. Follow up antegrade pyelography diagnosed hydronephrotic left kidney with stone in renal pelvis with fistula communicating to descending colon. Contrast enhanced computer tomography revealed left non excreting kidney with retrorenal colon and percutaneous nephrostomy tube passing through the descending colon. The final diagnosis of post percutaneous nephrostomy renocolic fistula with non excreting left kidney was made and treated with ligation of fistulous tract and nephrectomy. Patient had uneventful recovery and histopathology showed chronic pyelonephritis.

The role of ultrasonography in detection and localization of radiolucent foreign body in soft tissues of extremities

INTRODUCTION

Retained non-radiopaque foreign body inside soft tissue can be a cause of prolonged morbidity. Detection and localization is difficult task with conventional radiography. Ultrasonography, CT and MRI are other modes of evaluation but both of CT and MRI are expensive and not easily available.

METHODS

Twenty three patients were evaluated with ultrasonography (8 MHz linear probe) and X-ray for clinically suspicious non-radiopaque foreign body in soft tissue of extremities. Clinical presentation, duration of symptoms, anatomical location and foreign bodies retrieved after surgical explorations were recorded.

RESULTS

X-ray could not detect any foreign body in all 23 patients. Ultrasound findings were suggestive of foreign body in 19 patients (male: female=2:1, mean age 31.68+/-11.8 years, range 12 - 54 years) which was confirmed after surgical exploration except in one where only foreign body granuloma was found. 4 (21%) were not aware of prick injury. Fifteen patients had attempted removal of foreign body themselves or at medical shop or local health post. Interval between injury / symptoms appearance to hospital ranged from 4-56 days. Foot and ankle was involved in 10 (52.6%), calf in 3 (15%), dorsum of hand in 2 (10.5%), palm in 2 (10.5%), shoulder in 1 (5.2%) and knee in 1 (5.2%) case. Foreign bodies retrieved were wood in 12 (63%), thorn in 4 (21%) and bamboo twig in 2 (10.5%) patients.

CONCLUSION

Plain X-ray isn't sensitive for detection of non-radiopaque foreign body in soft tissue. Ultrasonography is sensitive and specific for detection and localization of foreign body which should be included in evaluation for clinically suspicious retained non-radiopaque foreign body in soft tissue of extremities.

The Role of Ultrasonography in Detection and Localization of Radiolucent Foreign Body in Soft Tissues of Extremities

INTRODUCTION:Retained non-radiopaque foreign body inside soft tissue can be a cause of prolonged morbidity. Detection and localization is difficult task with conventional radiography. Ultrasonography, CT and MRI are other modes of evaluation but both of CT and MRI are expensive and not easily available.METHODS:Twenty three patients were evaluated with ultrasonography (8 MHz linear probe) and X-ray for clinically suspicious non-radiopaque foreignbody in soft tissue of extremities. Clinical presentation, duration of symptoms, anatomical location and foreign bodies retrieved after surgical explorations were recorded.RESULTS:X-ray could not detect any foreign body in all 23 patients. Ultrasound findings were suggestive of foreign body in 19 patients (male: female=2:1, mean age 31.68+/-11.8 years, range 12 - 54 years) which was confirmed after surgical exploration except in one where only foreign bodygranuloma was found. 4 (21%) were not aware of prick injury. Fifteen patients had attempted removal of foreign body themselves or at medical shop or local health post. Interval between injury / symptoms appearance to hospital ranged from 4-56 days. Foot and ankle was involved in 10 (52.6%), calf in 3 (15%), dorsum of hand in 2 (10.5%), palm in 2 (10.5%), shoulder in 1 (5.2%) and knee in 1 (5.2%) case. Foreign bodies retrieved were wood in 12 (63%), thorn in 4 (21%) and bamboo twig in 2 (10.5%) patients.CONCLUSION:Plain X-ray isn't sensitive for detection of non-radiopaque foreign body in soft tissue. Ultrasonography is sensitive and specific fordetection and localization of foreign body which should be included in evaluation for clinically suspicious retained non-radiopaque foreign body in softtissue of extremities.KEYWORDS:non-radiopaque foreign body; sensitivity; specificity; ultrasonography

Renal Transplantation: Experience at a Single Centre

BACKGROUND

Renal transplantation program in the Armed Forces commenced in Feb 1991 and till date 245 patients have undergone renal transplantation at INHS Asvini. We describe our protocols for donor and recipient evaluation and immunosuppression.

METHODS

245 patients received renal transplants during this period, 243 (99.2%) being from live donors. Most of them were started on triple immunosuppression comprising of cyclosporine, azathioprine and prednisolone. Newer drugs like mycophenolate, tacrolimus and sirolimus were administered in a select population.

RESULT

69 (28.1%) of them had at least one episode of acute rejection, most of which were steroid responsive and 13 (18.8%) of them required either anti CD3 monoclonal or anti-thymocyte globulin (ATG). Complete recovery with normal renal function occurred in 54 (78.2%) cases and 15 (21.7%) recovered with residual dysfunction with maximum serum creatinine being 2.1mg/dl. There were three (1.2%) cases of accelerated rejection during the first week of transplantation and one had graft rupture. All three lost their grafts. There were eight (3.2%) cases of acute tubular necrosis, who recovered completely within 8-14 days. Immediate infections included wound sepsis, lower respiratory tract infection, disseminated candidiasis and disseminated aspergillosis. Late infections included pulmonary tuberculosis, disseminated tuberculosis, cytomegalovirus infection and recurrent urinary tract infection. 28 (11.4%) patients developed post transplant diabetes mellitus. At the end of one year and five years, graft and patient survival were 97.2%, 93%, 80.9% and 85.7% respectively.

CONCLUSION

Our outcomes show that the transplantation is a viable mode of renal replacement therapy in patients of end stage kidney disease with a near normal rehabilitation.

Intrathyroid metastasis presenting as a solitary thyroid nodule: an unusual case of clinically silent lung cancer

Metastases in the thyroid gland are very rare. Carcinoma lung is one of the tumours, which may metastasize to the thyroid. We report a 60-year-old lady with intrathyroid metastasis presenting as a solitary thyroid nodule. Fine needle aspiration cytology from the nodule showed features of metastatic adenocarcinoma. Further detail evaluation revealed primary lung adenocarcinoma with secondaries to adrenals, retroperitoneal and bilateral axillary nodes. This report emphasizes this unusual clinical presentation of carcinoma lung with wide spread secondaries; and a solitary thyroid nodule can be a presenting complain of a metastatic disease.

Antenatal detection of conjoined twin

Conjoined twin is a sporadic event with prevalence of 1 in 50000 to 1000000 birth. Incomplete division of embryonic disc results in conjoined twin. Ultrasound plays a major role for early detection and proper obstetric management. A case of cephalothoracopagus conjoined twin was detected at 20 weeks pregnancy in a primigravida woman by antenatal ultrasound. The pregnancy was terminated after proper counseling, despite the need to save the baby, as multidisciplinary team to separate the twins was not available.

Cervical spine injuries in a teaching hospital of eastern region of Nepal: a clinico-epidemiological study

Cervical spine injuries with neural deficits carry significant impact economically, socially and psychologically to the individual and to the society. Risk factors involved, mode of injuries, constraints of management and rehabilitation are different in developing countries. Total 149 patients of cervical spine injuries presented in B.P. Koirala Institute of Health Sciences, Dharan, Nepal were evaluated prospectively for three years. Demographic details, etiology of injury, method and time taken for transportation and treatment method and progression of recovery were recorded. Most commonly involved age group was 30-49 years (44%) with male to female ratio of 4:1. Fall related injury especially from trees was the commonest mode of injury (60%). Patients were transported to hospital without neck immobilization (81%) in a vehicle unsuitable for spinal injuries patient with average delay of two days of injury. 79% had neural deficits among which 42% are with quadriparesis, 31% are with quadriplegia. Associated extra spinal injuries were found in 9% patients. Average hospital stay was 31 days. C5 vertebra was the most commonly injured vertebra. Cervical spine injuries, which has major impact over patient and society is still not adequately addressed by medical and public health system of developing countries like Nepal. Incidence of spinal injuries and its devastating consequences can be reduced by appropriate preventive measures and management along with rehabilitation.

Intravesical foreign body: case report

Foreign bodies of the urinary bladder may occur by self insertion or migration from the neighbouring organs. All the foreign bodies when left for long act as a nidus for calculus formation. The patient usually presents with dysuria, intermittent urinary tract infection or suprapubic pain. Here we report two cases of vesical foreign body which was removed by the cystoscopy.

Clinico-radiological profile of stroke in eastern Nepal: a computed tomographic study

AIM

Stroke is a frequent cause of death and disability in elderly patients. This study was carried out to establish the pattern of various types of cerebrovascular accident (CVA) in eastern Nepal and to correlate the clinical data and radiological findings in cases of stroke.

MATERIALS AND METHODS

All the patients clinically diagnosed as stroke and referred to the radiology department for Computed tomography (CT) of the brain over a period of 1 year were included.

RESULTS

There were 150 patients with stroke (104 males and 46 females), aged 7 to 91 years in which infarction (58%) was more common than haemorrhage (42%) in both group of age (< or = 40 years and > 40 years). Smoking was the commonest risk factor noted in 40.66% cases followed by hypertension (40%). Excessive meat consumption (more than 4 times a week) was seen in 69.1% cases. In early Middle Cerebral Artery (MCA) territory infarction presenting within six hours of onset, positive CT findings were seen in 40% cases among which, obscuration of the lentiform nuclei was diagnostic.

CONCLUSION

In this part of Nepal, infarction is more common than haemorrhage as the cause of stroke and in contrary to western population; hemorrhagic stroke constitutes a significantly higher proportion of stroke. Smoking is the commonest risk factor followed by hypertension and it is also seen in combination with alcohol in many cases. Excessive meat consumption could be an additional risk factor for stroke in this part of Nepal. In younger age group (< or = 40 years), haemorrhage is more common than infarction and alcohol consumption is the commonest risk factor.

First year donation patterns predict long-term commitment for first-time donors

BACKGROUND AND OBJECTIVES

Converting first-time donors to become regular donors continues to be a challenge facing blood centres. We examined whether first-time donors with frequent return in the first 12 months were more likely to become regular donors.

SUBJECTS AND METHODS

The donation histories of 179 409 community whole-blood donors, whose first-time donation in 1991 was negative on donor screening tests, were evaluated. Donors were categorized by the number of donations made in the 12 months after (and including) their first donation. The donor return pattern in the subsequent 6 years, and its association with first-year donation frequency and demographics, was evaluated by using logistic regression analysis. A 'regular donor' was defined as one who returned to donate in at least 4 of the 6 years of follow-up.

RESULTS

First-year donation frequency was significantly correlated with long-term donor return (P < 0.0001). Among those giving 1, 2, 3, 4 and > or = 5 donations in the first year, 4%, 11%, 21%, 32% and 42%, respectively, became regular donors (P < 0.0001). Similar associations between donation pattern and donor return behaviour were observed after adjusting for demographic variables (P < 0.0001).

CONCLUSIONS

Strategies aimed at encouraging current donors to donate more frequently during the first year may help to establish a regular donation behaviour.

Roundworm infestation presenting as acute abdomen in four cases--sonographic diagnosis

Infestation with Ascaris lumbricoides (roundworm) is very common in the tropics and subtropics. Patients with ascariasis can be asymptomatic or may present with different clinical features in the form of simple nausea, decreased appetite, abdominal pain or more severe bowel obstruction, perforation, intussusception, biliary colic etc. Ultrasonography (USG) can be quick, safe, noninvasive and relatively inexpensive tool in diagnosing the presence of worms and also evaluating response to treatment (1, 2, and 3). Here we present four cases of roundworm infestation presenting with acute abdomen in the emergency department, which were diagnosed by USG and further imaging features of ascariasis on USG is described.

Aortic aneurysm and dissection: evaluation with spiral CT angiography

The study was undertaken for aortic evaluation and to see its usefulness for assessing aortic aneurysm, aortic dissection and pseudoaneurysm by spiral CT angiography (CTA). A total of 28 patients with aortic aneurysm (n=19), aortic dissection (n=5) and aortic pseudoaneurysm (n=4) were included. CTA findings were compared with ultrasonography in 14, digital subtraction angiography (DSA) in 14, MRI in 9; and surgical findings in 12 patients. CTA was an excellent imaging modality for comprehensive evaluation of aortic aneurysm, dissection and pseudoaneurysm combining the advantage of conventional contrast enhanced CT axial images and those of angiography in the form of 3D reformatted images.

Knowledge of HIV/AIDS transmission and screening in United States blood donors

BACKGROUND

Increased knowledge of HIV transmission and behavioral and test screening may encourage high-risk blood donors to self-defer.

STUDY DESIGN AND METHODS

Knowledge of HIV transmission and screening and the association with demographics, screening test reactivity, and unreported deferrable risks (UDRs) was assessed by a 1998 anonymous mail survey sent to 92,581 blood donors, of whom 57 percent responded. Groups were compared by using weighted chi-square tests and logistic regression analysis.

RESULTS

Four percent of the donors thought that it was very likely or somewhat likely for a person to contract HIV from donating blood, and 20 percent perceived a similar risk from blood transfusion. Only 60 percent of the donors knew that the available screening tests may not detect a recent infection. Thirty-seven percent either did not know or felt it was acceptable to donate blood to obtain HIV testing. Those most likely to answer knowledge questions incorrectly were more likely to have a higher prevalence of test reactivity or UDRs and to be <or=25 years old, members of a minority, less educated, non-US-born, or first-time donors.

CONCLUSION

Innovative ways to increase donor understanding of the implications of risk behaviors and the limitations of current screening procedures should be developed. They might prevent high-risk individuals from donating blood.

Incidence rates of viral infections among repeat donors:are frequent donors safer?

BACKGROUND

Incidence rates (IRs) for viral infections may vary with the frequency of donation among repeat, community, whole-blood (WB) donors, with IRs thought to be lower among donors with higher frequency of donation.

STUDY DESIGN AND METHODS

IRs for HIV, HTLV, HCV, and HBV infection were stratified by frequency of donation among 868,403 repeat WB donors who gave approximately 4 million donations at five United States blood centers from 1991 through 96. All donors had given at least 2 donations during those years, with the first donation being nonreactive on confirmatory testing. Frequency of donation was measured in three ways: by the number of donations per year; at the time of donation, by the number of donations given within the preceding 2-year period; and by the number of donations given from 1991 through 1993.

RESULTS

The IRs for HIV, HCV, and HBV infection did not appear to differ among donors with lower or higher numbers of donation per year. However, the IR for HTLV infection decreased as the number of donations per year increased (p = 0.0004). IRs for all viral markers remained stable, regardless of the number of donations given within the 2-year period before the donation. Although IRs for HIV, HTLV, and HCV infection did not vary by the number of donations given in 1991 through 1993, the IR for HBV infection appeared to be lower in donors who gave more donations in that period (p = 0.01).

CONCLUSION

These findings do not provide evidence of a lower IR for transfusion-transmissible viral infections among repeat WB donors who give more frequently. Abbreviated screening histories for frequent repeat donors might not be advisable.

Study of the interaction between bacteriophage T4 asiA and Escherichia coli sigma(70), using the yeast two-hybrid system: neutralization of asiA toxicity to E. coli cells by coexpression of a truncated sigma(70) fragment

The interaction of T4 phage-encoded anti-sigma factor, asiA, and Escherichia coli sigma(70) was studied by using the yeast two-hybrid system. Truncation of sigma(70) to identify the minimum region involved in the interaction showed that the fragment containing amino acid residues proximal to the C terminus (residues 547 to 603) was sufficient for complexing to asiA. Studies also indicated that some of the truncated C-terminal fragments (residues 493 to 613) had higher affinity for asiA as judged by the increased beta-galactosidase activity. It is proposed that the observed higher affinity may be due to the unmasking of the binding region of asiA on the sigma protein. Advantage was taken of the increased affinity of truncated sigma(70) fragments to asiA in designing a coexpression system wherein the toxicity of asiA expression in E. coli could be neutralized and the complex of truncated sigma(70) and asiA could be expressed in large quantities and purified.

A novel factor produced by placental cells with activity against HIV-1

The factors controlling the dynamics of HIV-1 transmission from mother to infant are not clearly known. Previous studies have suggested the existence of maternal and placental protective mechanisms that inhibit viral replication in utero. Preliminary studies from our laboratory revealed that supernatant from placental stromal cells protected HIV-1-infected PBMC from virus-induced apoptosis and suppressed virus production. We have attempted to characterize the antiviral activity of this placental factor (PF) and delineate the stages of HIV-1 replication affected. This activity was not due to the presence of any known cytokine reported to have anti-HIV effect. Direct exposure to PF had no suppressive effect on the infectivity of cell-free HIV-1, and envelope-mediated membrane fusion appeared to be unaffected. Western blot analysis of HIV-1 from infected PBMC treated with PF revealed that expression of all viral proteins was reduced proportionately, both intracellularly and in released virions. However, exposure of HIV-1-infected cells to PF resulted in production of virions with 10-100-fold-reduced infectivity. PF-treated virions contained two- to threefold reduced ratios of cyclophilin A:Gag protein as compared with untreated virus. Reduced cyclophilin A content resulting in decreased binding of cyclophilin A to Gag could account, in part, for the observed reduction in infectivity. Our results suggest that placental cells produce an antiviral factor that protects the fetus during gestation and may have therapeutic potential.

Chemokine-independent in vitro resistance to human immunodeficiency virus (HIV-1) correlating with low viremia in long-term and recently infected HIV-1-positive persons

Chemokines have been implicated as protective factors against human immunodeficiency virus (HIV) infection, competing for binding to receptors that also function as coreceptors for HIV. In this study of HIV-positive donors, peripheral blood mononuclear cell (PBMC) culture resistance to endogenous and exogenous HIV correlated with low plasma viremia and high in vitro RANTES production. However, resistant cells were not rendered susceptible by neutralization of C-C chemokines, and addition of C-C chemokines did not consistently suppress endogenous virus or exogenous HIV-1MN. In contrast, CD8 T cell depletion markedly decreased the frequency of resistant cultures without reducing C-C chemokine production. Among newly infected persons, half exhibited phenotype switching from preinfection susceptibility to postinfection resistance, suggesting that genetically predetermined constitutive cytokine production or allelic receptor expression are not generally responsible for in vitro resistance and nonprogression.

Breast-feeding and human immunodeficiency virus

Breast-feeding provides nutritional, immunological, and psychological benefits. It protects children from mortality and morbidity associated with diarrheal diseases, pneumonia and other infections. Breast feeding has also been shown to prolong the interval between births and thereby improve child survival and maternal health. However, studies suggest that in certain populations, breast feeding may account for nearly 14% of perinatal human immunodeficiency virus type 1 (HIV-1) transmission. It is therefore important that the risk of HIV-1 infection through breast feeding be weighed against the morbidity and mortality associated with bottle feeding. This paper discusses the literature dealing with breast feeding in women with HIV-1 infection. Specifically, the review addresses the issues surrounding infant mortality in areas of different HIV-1 prevalence where breast-feeding or bottle-feeding may be employed. Analysis suggests that the benefits of breast-feeding or bottle-feeding may be employed. Analysis suggests that the benefits of breast-feeding can substantially outweigh the putative risk of HIV-1 transmission unless the prevalence of HIV-1 infection is high or the difference in mortality between breast-fed and bottle-fed infants is very low.

Diagnosis of human immunodeficiency virus infection using citrated whole blood

Standard isolation of human immunodeficiency virus type 1 (HIV-1) from peripheral blood mononuclear cells (PBMC) requires 5 to 20 ml of blood, and the centrifugal separation of PBMC is expensive and time-consuming. Whole-blood coculture techniques use small sample volumes, do not require centrifugation, and allow measurement of the total viral burden in peripheral circulation. We compared the results of citrated whole-blood coculture with those obtained by the standard AIDS Clinical Trials Group PBMC semiquantitative culture method and reverse transcription-PCR quantitation of plasma HIV-1 RNA levels. PBMC cocultures were also set up with added erythrocytes (RBCs) to determine if the presence of RBCs affects the replication of HIV-1 in vitro. The mean number of cells required for a p24-positive PBMC coculture was approximately seven times greater than that required for a positive citrated whole-blood coculture (P < 0.01). At volumes of 100, 50, and 25 microl, the sensitivities of the whole-blood coculture were 94.5, 93.6, and 87.3%, respectively. The PBMC culture in the presence of added RBCs was more sensitive than PBMC coculture alone. The citrated whole-blood coculture was simple to perform, produced a reliable diagnosis of HIV infection in adult volunteers, was more sensitive than previously reported techniques even in half the culture time, and showed less variability than the PBMC coculture. Citrated whole-blood coculture may be a useful and efficient tool for diagnosing infection with HIV-1.

Failure of insulin-like growth factor type I to suppress HIV type 1 in adult or umbilical cord mononuclear blood cells

Insulin-like growth factor type I (IGF-I) has been used as a treatment for cachexia in adults with AIDS and has been reported to show inhibitory activity against HIV-1IIIB in cord blood mononuclear cells (CBMCs) in vitro at low-concentration (1%) fetal bovine serum (FCS). We evaluated the effect of IGF-I on MN, IIIB, and BaL strains, as well as on a patient isolate of HIV-1 in CBMCs and adult peripheral blood mononuclear cells (PBMCs). IGF-I failed to show any inhibitory effect on HIV replication in CBMCs or adult PBMCs under various culture conditions. In contrast to an earlier report of an antiviral effect, IGF-I augmented HIV-1 replication in PHA-stimulated PBMCs maintained in a low concentration of FCS.

Expression and characterization of the ponA (ORF I) gene of Haemophilus influenzae: functional complementation in a heterologous system

The coding sequence of the Haemophilus influenzae ORF I gene was amplified by PCR and cloned into different Escherichia coli expression vectors. The ORF I-encoded protein was approximately 90 kDa and bound 3H-benzyl-penicillin and 125I-cephradine. This high-molecular-weight penicillin-binding protein (PBP) was also shown to possess transglycosylase activity, indicating that the ORF I product is a bifunctional PBP. The ORF I protein was capable of maintaining the viability of E. coli delta ponA ponB::spcr cells in transcomplementation experiments, establishing the functional relevance of the significant amino acid homology seen between E. coli PBP 1A and 1B and the H. influenzae ORF I product. In addition, the physiological functioning of the H. influenzae ORF I (PBP 1A) product in a heterologous species established the ability of the enzyme not only to recognize the E. coli substrate but also to interact with heterologous cell division proteins. The affinity of the ORF I product for 3H-benzylpenicillin and 125I-cephradine, the MIC of beta-lactams for E. coli delta ponA ponB::spcr expressing the ORF I gene, and the amino acid alignment of the PBP 1 family of high-molecular-weight PBPs group the ORF I protein into the PBP 1A family of high-molecular-weight PBPs.