Neutrophil chemorepulsion in defined interleukin-8 gradients in vitro and in vivo

We report for the first time that primary human neutrophils can undergo persistent, directionally biased movement away from a chemokine in vitro and in vivo, termed chemorepulsion or fugetaxis. Robust neutrophil chemorepulsion in microfluidic gradients of interleukin-8 (IL-8; CXC chemokine ligand 8) was dependent on the absolute concentration of chemokine, CXC chemokine receptor 2 (CXCR2), and was associated with polarization of cytoskeletal elements and signaling molecules involved in chemotaxis and leading edge formation. Like chemoattraction, chemorepulsion was pertussis toxin-sensitive and dependent on phosphoinositide-3 kinase, RhoGTPases, and associated proteins. Perturbation of neutrophil intracytoplasmic cyclic adenosine monophosphate concentrations and the activity of protein kinase C isoforms modulated directional bias and persistence of motility and could convert a chemorepellent to a chemoattractant response. Neutrophil chemorepulsion to an IL-8 ortholog was also demonstrated and quantified in a rat model of inflammation. The finding that neutrophils undergo chemorepulsion in response to continuous chemokine gradients expands the paradigm by which neutrophil migration is understood and may reveal a novel approach to our understanding of the homeostatic regulation of inflammation.

Phase diagram studies in two-surfactant ternary systems employing positron annihilation spectroscopy

Positron annihilation lifetime parameters in condensed media are sensitive to structural and conformational changes. This property has been exploited to study the phase diagrams of two ternary cationic surfactant systems. Positron lifetime measurements were performed in cetyltrimethylammonium bromide (CTAB)/water/hexanol and tetradecyltrimethylammonium bromide (TTAB)/water/pentanol systems having varying concentrations of hexanol and pentanol respectively. For both the systems, changes were observed in the positron lifetime parameters whenever a phase transformation occurred. The various phase boundaries demarcated by this technique agrees well with those obtained by other conventional techniques. Besides this, the present work suggests the existence of two kinds of lamellar structures referred to as DI and DII phases in both the systems, which were otherwise considered to be a single D phase by other conventional techniques. The existence of such lamellar structures has been demonstrated by a change in the trend of o-Ps lifetime when the system passes from one type of lamellar structure to the other type. The results of these investigations are presented.

B-Lynch brace suture: an effective method of conservative surgical management for placenta increta

Placenta accreta is defined as an abnormal adherence, either in whole or in part, of the afterbirth to the underlying uterine wall. Placenta increta occurs when the placenta invades deeply into the myometrium. Placenta increta is a life threatening condition. We report a case of placenta increta managed by unilateral uterine artery and ovarian artery ligation followed by B-Lynch Brace suturing of the uterus to control bleeding from the placental bed.

Experimental pathogenicity evaluation of Mycoplasma canadense from bovine mastitis in vitro and in vivo laboratory models

Mycoplasma canadense, a clinical isolate from milk of a mastitic buffalo, was experimentally tested for its pathogenic potential in hamster tracheal ring and rabbit fallopian tube explant organ cultures (in vitro) and rat and rabbit mammary gland (in vivo) models. The activity percentage reduction in M. canadense infected hamster tracheal rings was 99.1% in comparison to 16.4% in control rings. Mycoplasma canadense, also induced complete ciliostasis at 11-day post-infection in rabbit fallopian tube explants. Histopathological lesions in these infected organ cultures were loss of cilia, desquamation or denudation of epithelium, infiltration of inflammatory cells and proliferation of macrophages as well as oedema in lamina propria. At the end of the experiments, M. canadense organisms were reisolated in pure colonies from the infected but not the control organ cultures. In the rat and rabbit mammary glands, M. canadense organisms persisted upto 6-day and 7-day postinfection, respectively and caused histopathological changes suggestive of subacute to chronic mastitis during the experimental period. The results indicate that the tested M. canadense clinical isolate was virulent.

Pulmonary functions in patients with type 2 diabetes mellitus & correlation with anthropometry & microvascular complications

BACKGROUND & OBJECTIVES

The purpose of this study was to evaluate pulmonary functions including respiratory muscle strength in patients with type 2 diabetes mellitus (T2DM) and to determine their correlations with anthropometric profile, glycaemic control, and microangiopathic diabetic complications.

METHODS

Twenty nine patients with T2DM and 11 healthy control subjects were divided into the following three groups; (i) T2DM patients with any or a combination of microangiopathy(ies) (retinopathy, nephropathy, and peripheral neuropathy) (group 1, n=12); (ii) T2DM patients without any complications (group 2, n = 17); and (iii) a healthy control group (group 3, n=11). All patients were assessed with anthropometry, glycosylated haemoglobin (HbA1C), and lipid profile. Pulmonary functions were measured by spirometry. Pulmonary diffusion capacity for carbon monoxide (DLco) was measured by the steady state method. The presence of diabetic nephropathy was determined by 24 h protein excretion.

RESULTS

A significant reduction of DLco was observed in group 1 (P<0.001), as compared to the other groups. There were no differences among the three groups for other pulmonary functions; forced vital capacity, forced expired volume in one second, peak expiratory flow rate, and maximal static inspiratory and expiratory pressures. Significant correlations were observed between DLco and the following parameters in group 1; HbA1c (r=0.62, P<0.05), total cholesterol level (r = -0.44, P<0.05) and creatinine clearance (r=0.42, P<0.05).

INTERPRETATION & CONCLUSION

The present study shows that the impairment of pulmonary diffusion capacity for carbon monoxide was common in T2DM Asian Indian patients having microangiopathy. Pathophysiologically, it could be related to glycaemic control or dyslipidaemia. Correlation of % BF with DLCo needs to be explored further.

Worm infestation and anaemia: a public health problem among tribal pre-school children of Madhya Pradesh

A study to assess the status of intestinal parasitosis and anaemia was carried out among the pre-school children of Gond tribal community in Kundam block of Jabalpur district, Madhya Pradesh. A total of 985 pre-school children were covered. The results revealed that 48% pre-school children had intestinal parasitic infections. Common parasites observed among them were Hymenolepis nana, hookworms and roundworms. Mean epg for these parasites ranged from 371.2 to 1221.8. High prevalence of anaemia (86.7%) was also observed among them. This high prevalence of intestinal parasitic infections and anaemia could be due to indiscriminate defecation, low socio-economic status, ignorance and low standard of personal hygiene. Comprehensive control strategy with specific intervention measures need to be evolved and implemented specially in tribals as serious efforts are being madeby the Govt. for their overall development.

Coronary angiography using 4 French catheters with power injection: a randomized comparison with 6 French catheters

BACKGROUND

Coronary angiography using 4 F catheters may reduce access-site complications and enable early ambulation, although earlier studies suggested that the quality of images may be an issue of concern.

METHODS AND RESULTS

To ascertain the quality of angiographic images and safety of early ambulation, 500 patients were randomized to coronary angiography with either 4 F or 6 F catheters. Procedural characteristics, angiographic quality scores and results of ambulation were analyzed in the two groups. Patients in the 4 F group were mobilized at 2 hours post-procedure while those in the 6 F group were ambulated at 6 hours. There was no procedure-related complication in either group. The procedure was successfully completed in 250 of 252 patients randomized to the 4 F group. In two patients in the 4 F group, sheaths were upgraded to 6 F to complete the procedure, as difficulty was encountered in hooking the coronary ostium with a 4 F Judkin's catheter. Coronary angiographic quality scores in these two groups were comparable. Angiographic scores for the 4 F and 6 F groups for the left coronary artery averaged 4.45+/-0.5 and 4.58+/-0.3 (p>0.1), respectively. The right coronary artery scores averaged 4.30+/-0.4 and 4.35+/-0.2 (p>0.1) in the 4 F and 6 F groups. Angiographic scores for the left ventricular angiogram averaged 4.22+/-0.1 and 4.44+/-0.3 (p>0.1) in the 4 F and 6 F groups, respectively. None of the angiograms were assigned a score of <3.0 (not diagnostic). The total contrast volume consumed in the two groups was also equivalent. There were no groin-related complications in the 4 F group although these patients were ambulated 2 hours after the procedure.

CONCLUSIONS

Coronary angiography performed with a 4 F catheter is a safe and reliable procedure. The quality of image obtained with a 4 F catheter is equivalent to that obtained with a 6 F catheter. Early ambulation at 2 hours is feasible without compromising safety.

Graded balloon atrial septostomy in severe pulmonary hypertension

BACKGROUND

The prognosis of patients with severe primary pulmonary hypertension is poor. The role of balloon atrial septostomy as a palliative procedure in these patients is not well defined. We retrospectively analyzed our data regarding the safety, clinical outcome and survival benefit of graded balloon atrial septostomy in patients with severe pulmonary hypertension.

METHODS AND RESULTS

Eleven patients (7 males), aged 6 to 30 years (mean age 16.2+/-8.9 years), with severe pulmonary artery hypertension (mean pulmonary artery pressure of 76+/-16.9 mmHg) and refractory congestive heart failure and/or recurrent syncope underwent balloon atrial septostomy. Graded balloon dilatation under echocardiographic guidance and arterial oxygen saturation monitoring was done in all the patients. Procedure-related mortality was 18.2%. Significant acute hemodynamic improvement was seen in the survivors (pre-balloon atrial septostomy cardiac index 1.88+/-0.48 L/min/m2; post-balloon atrial septostomy cardiac index 2.18+/-0.37 L/min/m2, p<0.009). Patients were followed up for a mean period of 20.3 months after the procedure (range: 3 months-5 years). There was functional improvement and increased exercise tolerance in all the patients for a mean follow-up period of 14.6 months (NYHA functional class 3.62+/-0.69 to 2+/-0.50). The estimated probability of survival in this cohort at 1 year was only 48%; but 7 of 8 patients (87%) who survived the procedure were alive at 1 year.

CONCLUSION

We conclude that balloon atrial septostomy improves clinical status, hemodynamic variables and possibly also improves survival in selected patients with severe pulmonary artery hypertension. It remains a definite palliative option for refractory primary pulmonary hypertension. However, the procedure-related risks are high in very sick patients and, therefore, balloon atrial septostomy may be advocated early in the course of the disease.

Bilateral choanal atresia--respiratory emergency in a neonate

Bilateral choanal atresia is potentially a fatal respiratory emergency in a newborn. A 2-day-old full term male infant was presented with history of attacks of cyanosis, difficulty in suckling and respiration. On examination cyclical change of body colour, ie, alternating cyanosis and normal colour was observed. CT scan of the base of the skull revealed bilateral choanal atresia. The patient underwent choanal canalisation operation by transnasal route using Lichtwitz trocar and cannula with controlled force.

Pancreatoblastoma

Pancreatoblastoma is an extremely rare pancreatic tumor in childhood, comprising 0.5% of pancreatic non endocrine tumors. Just over 50 cases have been reported in the literature till 1997. A 10 year-old male child presented with mass abdomen of 9 months duration. USG and CT abdomen showed a large mixed density lobulated mass in abdomen anterior to, and displacing down the portal vein and splenic veins. Exploratory laparotomy revealed a large mass, arising from body and tail of pancreas, not infiltrating the adjacent structures. Complete excision of the mass along with removal of body and tail of pancreas was done. The histopathological examination revealed pancreatoblastoma. He is well without any evidence of disease 6 months after the operation. To the best of our knowledge this is the first case of pancreatoblastoma with a large size (25 x 20 x 15 cm,) weight 2.5 kg, which was localized and where complete excision was possible. The largest size reported in the literature reviews has been around 15 cm. The literature review confirms that an aggressive surgical attack on resectable pancreatoblastoma may often be curative. The role of adjuvant chemotherapy or radiotherapy is still under discussion due to small number of patients treated as yet.

Cervical node metastasis in Carcinoma of Pyriform Sinus: A prospective analysis of prevalence and distribution

The present study included 28 cases of carcinoma of pyriform sinus admitted in ENT ward of SMS Hospital in year 2000. The present work has been undertaken to analyse the prevalence and distribution of cervical lymph node metastases in cases of Pyriform sinus carcinoma, to compare the incidence and distribution of lymph node metastasis in medial vs lateral wall pyriform sinus carcinoma and to review the case of pyriform sinus carcinoma in reference to symptoms, clinical features and histopathological tumor staging.Most of the patients were in 6(th) decade of life. Sex incidence observed was male 93% and female 7% Histological variety was moderately differentiated squamous cell carcinoma (46.5%) which differs from the previous studies reporting the commonest variety to be poorly differentiated squamous cell carcinoma.It was observed in this series that 60% cases were of malignancy medial wall of pyriform fossa and 40% cases were of both lateral and medial wall. In contrast to previous studies which suggested that chances of contralateral cervical metastases was more with carcinoma involving medial wall of pyriform sinus, we observed equal incidence of contralateral node metastases in both group of pyriform sinus carcinoma case.In the present study 75% cases presented to us with T(4) stage. Though there were 4 cases of T(1) tumor in present series but none were in TNM stage I or II. This indicates that there is essentially no difference in the risk of lymph node metastases by T-stage.

Lymphangioma circumscriptum of the vulva mimicking genital wart: a case report and review of literature

Lymphangioma circumscriptum (LC) is an uncommon dermatologic problem that rarely affects the vulva and it is considered to be a localised developmental defect of lymphatic tissue in the dermis. We report a case of vulval LC, clinically diagnosed as genital wart, in a 48-year-old woman without evidence of secondary lymphatic damage. The patient required extensive vulval surgery and there was no recurrence after 16 months.

Effect of cancer treatment modalities on serum lipids and lipoproteins among women with carcinoma of the breast

Serum lipids and lipoproteins were studied in 61 breast cancer patients before initiation of therapy and subsequently during and after completion of cancer therapy. Different serum lipid fractions were estimated by enzymatic method. It was observed that mean levels of serum triglycerides, total cholesterol and low density lipoprotein (LDL)-cholesterol among untreated breast cancer patients decreased significantly after treatment. On the contrary, an increasing trend in the levels of high density lipoprotein (HDL)-cholesterol was noticed in patients during the course of treatment. This study reflects the effects of cancer therapy in the alteration of levels of different serum lipid fractions in the patients with breast cancer.

Intravascular ultrasound-guided angioplasty and stenting in a case of transplant coronary artery disease

Allograft vasculopathy in cardiac transplant recipients occurs commonly at 5 years post transplantation. We report a case of post-transplant right coronary discrete stenosis which was treated with balloon angioplasty and stent implantation under intravascular ultrasound guidance.

Antifertility effect of aqueous extract of seeds of Cassia fistula in female rats

Oral administration of aqueous extract of seeds of Cassia fistula to mated female rats from day 1-5 of pregnancy at the doses of 100 and 200 mg/kg body weight resulted in 57.14% and 71.43% prevention of pregnancy, respectively, whereas 100% pregnancy inhibition was noted at 500 mg/kg bw. In the uterine bioassay test carried out in immature bilaterally ovariectomized female rats, aqueous extract of seeds of Cassia fistula (100 mg/kg bw) increased the uterine wet weight (p<0.05) and luminal epithelial cell height (p<0.001) but did not induce premature opening of the vagina. This suggests a mild estrogenic activity of the extract. However, when the extract was administered conjointly with estradiol valerate (EDV, 0.1 mg/kg bw), it significantly (p<0.001) prevented the estrogen-induced uterotrophic effect, thus showing an antiestrogenic nature of the extract in the presence of a strong estrogen.

Mania in Parkinson's disease with treatment emergent dyskineisa : a case report

A case of parkinson's disease starting 7 yrs. ago in 1993 with 2 episodes of mania is presented. The 1st episode (1993) was of 1-1/2 months duration, when early parkinsons symptoms had already set in. This was treated with anti-psychotic medications for a month, the picture was complicated with stroke and post-stroke sequlae for 5-6 months, where anti-psychotics were continued. He developed dyskinesia, when antipsychotics were stopped. The patient was on selegiline for Parkinson's disease for 2 years and off all medications subsequently. The 2nd episode of mania occurred after 7 years in January 2000. This episode of mania lasting for 2 months duration was treated with divalproate sodium and I-dopa for Parkinson's. Treatment emergent dyskinesia had to be treated with Clozapine. This unusual combination of bipolar-l disorer (2 episodes of mania) with Parkinson's disease and treatment emergent dyskinesia is presented with management strategy.

Relationship between clinical conditions and CD4 counts in HIV-infected persons in Pune, Maharashtra, India

BACKGROUND

A decade after the detection of human immunodeficiency virus (HIV) infection in India, a steady increase in the number of patients with acquired immunodeficiency syndrome (AIDS) has been observed. The therapeutic options for patients with AIDS in developing countries include chemoprophylaxis and identifying and treating opportunistic infections. CD4 counts help in clinical monitoring and making decisions about initiating antiretroviral therapy or chemoprophylaxis. Flowcytometry is expensive and available only at specialized laboratories. Therefore, the possibility of using clinical indicators to predict low CD4 counts and disease progression needs to be explored.

METHODS

This cross-sectional study was conducted among 137 HIV-infected persons investigated at an HIV reference centre in Pune. The study methods comprised pre-test counselling, informed consent, blood withdrawal and clinical evaluation. Serum samples were tested for HIV and CD4 counts were estimated on FACSort.

RESULTS

Study participants commonly reported with oral candidiasis, herpes zoster, pulmonary tuberculosis, lymphadenopathy, weight loss, rash, diarrhoea and fever. CD4 counts were significantly lower among men, symptomatic patients and those with oral candidiasis, weight loss and multiple clinical conditions. The sensitivity of most of the clinical conditions was low, the specificity was high and the positive predictive value of oral candidiasis and weight loss for low CD4 counts was > 75%.

CONCLUSION

The presence of oral candidiasis and weight loss were highly predictive of low CD4 counts and these can be considered as markers of HIV disease progression. Absence of clinical conditions was found to be a good predictor of high CD4 counts. Larger systematic natural history studies may help in identifying clinical conditions that could have a prognostic significance among HIV-infected people.

Assessment of iodine deficiency disorders in Meerut district, Uttar Pradesh

Iodine deficiency disorders (IDD) are an important public health problem in India. Meerut district, Uttar Pradesh, is a known IDD endemic area. A study conducted in 1986 reported a total goitre rate of 24.9% in the entire population of Meerut district. During 1990-97 intensive efforts were taken by the Uttar Pradesh Government to ensure universal availability of iodized salt to the population. No survey has been conducted since 1997 on the status of iodine deficiency in the Meerut district. Hence, the present study was conducted in order to assess the prevalence of IDD and to estimate the iodine content of salt consumed in the households of Meerut district, Uttar Pradesh. The 30 cluster sampling methodology and indicators for assessment of IDD as recommended by the joint WHO/UNICEF/ICCIDD (World Health Organization/United Nations Children's Fund/International Council for the Control of Iodine Deficiency Disorders) Consultation in full was utilized for the survey. A confidence level of 95%, relative precision of 10% and design effect of three were considered in the calculation of the sample size. The prevalence of goitre at the time of survey was estimated to be 15%. A total of 6485 school children in the 6-10 years age group were selected using probability proportionate to size cluster sampling methodology. A total goitre prevalence rate of 11.6% was found in the district. It was observed that 5.4, 2.9 and 19.9% of the children had urinary excretion levels of < 2.0, 2.0-4.9, and 5.0-9.9 μg/dL, respectively. The median urinary iodine excretion of the children studied was found to be 15.0 μg/dL. Fiftythree percent of the children studied consumed salt with an iodine content of less than 15 p.p.m., which was below the stipulated level (15 p.p.m.). The study showed that the population is in a transition phase from iodine deficient (as revealed by total goitre rate) to iodine sufficient (as revealed by median urinary iodine excretion of 15.0 μg/dL). There is a need to further strengthen the existing monitoring system for the quality of iodized salt in the district in order to achieve the elimination of IDD.

Clinical and echocardiographic predictors of left atrial clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis: a prospective study in 200 patients by transesophageal echocardiography

The objective of this study was to prospectively investigate various clinical and echocardiographic variables to predict the left atrial and left atrial appendage clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis. We studied 200 consecutive patients (112 males and 88 females; mean age 29.6+/-9.6 years). Left atrial clot and spontaneous echo contrast were present in 26 and 53.5% of cases, respectively. There were no significant differences in the mitral valve area, mean transmitral diastolic gradient and left ventricular ejection fraction between patients with and without clot. Patients with clot were older (34.4+/-11.4 vs. 28.2+/-8.5 years, P<0.001), had longer duration of symptoms (41. 4+/-36.0 vs. 28.8+/-22.9 months, P<0.001), more frequent atrial fibrillation and spontaneous echo contrast (69.2 vs. 16.9%, P<0. 00001 and 76.9 vs. 45.3%, P<0.00001, respectively) and larger left atrial area and diameter (41.0+/-12.7 vs. 29.9+/-7.4 cm(2), P<0.00001 and 53.9+/-8.3 vs. 47.6+/-7.4 mm, P<0.0001, respectively) as compared to patients without clot. Similarly patients with spontaneous echo contrast were older (31+/-10.4 vs. 27.8+/-8.3 years, P<0.01), had more frequent atrial fibrillation (48.6 vs. 9.7%, P<0.0001), left atrial clot (37.4 vs. 12.9%, P<0.0001), larger left atrial area and diameter (37.6+/-11.2 vs. 28.1+/-6.7 cm(2), P<0.00001 and 52.2+/-8.3 vs. 45.9+/-6.5 mm, P<0.00001, respectively) and smaller mitral valve area (0.77+/-0.14 vs. 0.84+/-0.13 cm(2), P<0.01) as compared to patients without spontaneous echo contrast. There were no significant differences in the mean transmitral diastolic gradient and left ventricular ejection fraction. On multiple regression and discriminant function analysis, atrial fibrillation and left atrial area were independent predictors of left atrial clot formation. In a subgroup of patients with sinus rhythm, larger left atrial area and presence of spontaneous echo contrast were significantly associated with the presence of clot in left atrium and appendage. We conclude that in patients with severe mitral stenosis, the presence of atrial fibrillation and in the subgroup of the patients with sinus rhythm the presence of large left atrium (> or =40 cm(2)) and spontaneous echo contrast were associated with higher risk of clot formation in the left atrium and might be benefited by prophylactic anticoagulation.

Right pulmonary artery left atrium communication

A 12-year-old boy presented with central cyanosis, clubbing, and ejection systolic murmur in the left second and third intercostal space. Chest roentgenogram showed a round opacity on the right border of cardiac silhouette. Echocardiography revealed a communication between right pulmonary artery and left atrium, which was later confirmed on selective pulmonary cineangiography. Successful surgical ligation without cardiopulmonary bypass resulted in the cure of the disease.