Tobacco and tuberculosis: a qualitative systematic review and meta-analysis

OBJECTIVES

To assess the strength of evidence in published articles for an association between smoking and passive exposure to tobacco smoke and various manifestations and outcomes of tuberculosis (TB). Clinicians and public health workers working to fight TB may not see a role for themselves in tobacco control because the association between tobacco and TB has not been widely accepted. A qualitative review and meta-analysis was therefore undertaken.

METHODS

Reference lists, PubMed, the database of the International Union Against Tuberculosis and Lung Disease and Google Scholar were searched for a final inclusion of 42 articles in English containing 53 outcomes for data extraction. A quality score was attributed to each study to classify the strength of evidence according to each TB outcome. A meta-analysis was then performed on results from included studies.

RESULTS

Despite the limitations in the data available, the evidence was rated as strong for an association between smoking and TB disease, moderate for the association between second-hand smoke exposure and TB disease and between smoking and retreatment TB disease, and limited for the association between smoking and tuberculous infection and between smoking and TB mortality. There was insufficient evidence to support an association of smoking and delay, default, slower smear conversion, greater severity of disease or drug-resistant TB or of second-hand tobacco smoke exposure and infection.

CONCLUSIONS

The association between smoking and TB disease appears to be causal. Smoking can have an important impact on many aspects of TB. Clinicians can confidently advise patients that quitting smoking and avoiding exposure to others' tobacco smoke are important measures in TB control.

Electron-temperature evolution in expanding ultracold neutral plasmas

We have used the free expansion of ultracold neutral plasmas as a time-resolved probe of electron temperature. A combination of experimental measurements of the ion expansion velocity and numerical simulations characterize the crossover from an elastic-collision regime at low initial Gamma(e), which is dominated by adiabatic cooling of the electrons, to the regime of high Gamma(e) in which inelastic processes drastically heat the electrons. We identify the time scales and relative contributions of various processes, and we experimentally show the importance of radiative decay and disorder-induced electron heating for the first time in ultracold neutral plasmas.

Rosai Dorfman disease--a clinico-pathological presentation

Rosai Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder that typically manifests as lymphadenopathy and systemic symptoms. The authors report a 45 year old lady who presented with nasal mass and generalised lymphadenopathy. Histopathological examination demonstrated lymphophagocytosis (emperipolesis) consistent with a diagnosis of RDD. The clinical and histologic aspects of the disease are discussed as a rare cause of generalised lymphadenopathy.

Result of childhood acute lymphoblastic leukemia protocol (INCTR) from a developing country

20015

Background: Acute Lymphatic Leukemia in children is a curable disease in the range of 80–90 % in developed Countries by aggressive protocol like BFM, St. Judes’. In developing Countries like ours, patients can’t tolerate those aggressive protocol because of Socio- economic and nutritional factors. The less aggressive Protocol like INCTR (International Network for Cancer Treatment & Research) are suitable in developing Countries like ours. The aim of our study was to see outcome of childhood ALL patient with INCTR protocol and tolerability of the protocol in Indian-asian population. Methods: We treated 480 Children (age range 1–25 years, median age of 11 yrs) with INCTR Protocol at Netaji Subhash Chandra Bose Cancer Research Institute, Kolkata, India, a tertiary cancer centre from Eastern India during period from April ’99 to Dec ’06. There was female preponderance in the study. Fever 283 (58.9%), lymphadenopathy 211 (43.9%) and haepatosplenomegaly 153 (31.8%) were the major clinical presentation. Forty-three (8.9%) patients were present with hyper Leukocytosis. C-ALL phenotype were the largest group though the incidence of the T-ALL were quite high (27.9%). Results: Remission induction were seen in 446 (92.9%) of the patient. In a follow-up period of 88 months (with an average of 54 months) the disease-free survival ( DFS) was 66.8% (321 patients) with an overall survival of 73.9% (355 patients). The isolated bone marrow relapse was seen in majority of the cases 40 (8.33%) and the major relapse was in maintenance and first 6 months of completion of therapy. The major cause of morbidity was infection 316 (65.8%) followed metabolic complications 81 (16.8%), hemorrhage 52 (10.8%), neurologic 10 (2.08%), hepatitis 6 (1.25%) and pancreatitis 5 (1.04%). The major cause of the mortality was infection 75%(360 patients) followed progressive disease 7.91% (38 patients) and Hemorrhage 5.83%( 28 patients). Conclusions: The data of acute lymphatic leukemia from a developing country is encouraging. The protocol was well tolerated by India- asian population.

No significant financial relationships to disclose.

Combination of gemcite and cisplatin chemotherapy in unresectables gall bladder cancer

15166

Background: Adenocarcinoma of the gall bladder accounts for approximately 4% of all malignant neoplasm of the gastro- intestinal tract. Though surgical resection is the treatment of choice, majority of the cases are unresectable. Different chemotherapeutic agents including 5Flurouracil, Mytomycin C, Cisplatin, Methotrexate, Etoposide and Doxorubicin have been tried single or in combination. Partial response lasting from weeks to several months have been observed only in about 10% - 20 % of the cases and the median survival for patients with gall bladder cancer is approximately 4 months. Gemcitabine has shown strong anti tumour activity in a variety of solid tumours. Cisplatin has synergistic activity with Gemcitabine. The aim of our study was to determine the response rate of Gemcitabine and Cisplatin combination in unresectable gall bladder cancer and to see the tolerability in Indian-Asian pollution. Methods: During period from November 2002 to December 2006 we selected 84 consecutive patients with histologicaly proven unresectable measurable, gall bladder cancer. The inclusion criteria were performance status more than 60% (Kornofsky) and normal liver (bilirubin < 2) and kidney function ( creatinine <2) function . All patient received Gemcitabine (1000mg/m2 intravenously over 30 minute) on day 1 and day 8 and Cisplatin total (100mg/m2 divided D1 to D3) every 21days. Response assessment was done by CT Scan after 3 cycles of chemotherapy. All 84 patients are eligible for efficacy and toxicity analysis. Results: There were 15 (17.8%) complete responders, 27 (32%) partial responders, 22 (26.1%) with stable disease and 20 (23.8%) shows disease progression. The median time to progression was 22 weeks (range 12- 30 weeks). The median duration of response was 16 weeks (range 5.6 - 60 weeks). The median over all survival was 24 weeks (range 11–32 weeks) with 1year survival rate of 20.2%. WHO grade III or IV anaemia was seen in 23 (18.63%) patients respectively. Sixteen (13.44%) patients experienced grade III or IV neutropenia while grade III or IV thompocytopenia was seen in 8 patients (6.72%). Conclusions: The present study showed the Gemcitabin & Cisplatine combination was very useful in advanced unresectable gall bladder cancer. It was well tolerated by the patients.

No significant financial relationships to disclose.

Oral chemotherapeutic agents in elderly acute myeloid leukemia (AML) patients, a study from a developing country

7057

Background: Almost 60% of the patients with Acute Myeloid Leukemia (AML) are over the age of 60 years. Age is one of the strongest adverse prognostic factor for AML, both for induction remission and for survival. Studies have shown that elderly patients have reduced tolerance to aggressive chemotherapy especially the myelosupressive effects. Elderly patients with Leukemia who receive intensive treatment often die as a result of chemotherapy. Aggressive chemotherapy is also costly which the relatives in developing country are reluctant to spend for the elderly patients. The aim of our study was to see the outcome, tolerability and cost effectiveness of oral chemotherapeutic agents. Methods: We selected consecutive 100 patients more than 50 years of age in haemato oncology department of NCRI (Netaji Subhas Chandra Bose Cancer Research Institute) during the period from Jan 2004 to Dec 2006. The mean age of the patients was 65 (range 50 –71) years. There was male preponderance. The inclusion criteria were performance status more than 60% (Kornofsky), Morphological, Cyto-Chemical and Immunophenotyping diagnosis of Acute Myeloid Leukemia (AML), normal liver (billirubine < 2) and kidney function ( Creatinine <2%). After the incent consent all patient were started oral chemotherapeutic agents 6 Mercptopurine (6MP) 75mg/m2. Etoposide 70mg/m2 and Prednisolone 40mg/m2. All agents are given 3 weeks followed by 7 days gap every month and continued for 6 months. Bone Marrow was repeated after 3rd & 6th course of chemotherapy. Results: Fifteen (15%) and thirtyeight patients (38%) had complete hematological response after 3rd & 6th course of chemotherapy. Seven patients (7%) died because of grade III/IV Neutropenia. Median duration of Myelosupression was 18 days (2 to 48 days).12% required hospitalisation. With median follow up of 19 months (range 2–36 months) the disease free survival (DFS) and over all survival (OS) was 18 % and 32 % respectively. Conclusions: The combination of oral chemotherapeutic agents consisting of 6MP, Etoposide & Prednisolone were well tolerated by elderly patients with good induction remission, low mortality and median survival. It was cheaper and well accepted by the patients.

No significant financial relationships to disclose.

Minimally invasive radioguided surgery for parathyroid adenomas (MIRP)

BACKGROUND

Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Conventional surgical management includes bilateral neck exploration with removal of the adenoma(s) and biopsy of one of the other glands with visualization of all glands. It is associated with a risk of permanent hypoparathyroidism. Radioguided excision of parathyroid adenoma is a widely accepted technique which provides accurate localization and complete excision of the lesion with low morbidity. We report our experience with this technique.

METHODS

We performed radioguided excision of parathyroid adenomas in 15 patients. All of them had preoperative localization of the adenoma using a dual tracer, dual phase 99mTc-Sestamibi scan. A dose of 8-10 mCi of 99mTc-Sestamibi was injected intravenously 2 hours before surgery. Under local anaesthesia, surgical excision of the lesion was done after localizing it using a hand-held gamma probe. Complete excision was confirmed by frozen. section of the excised lesion and an intraoperative quick parathormone assay.

RESULTS

The 99mTc-Sestamibi scan revealed an increased uptake by the adenoma in all patients and complete excision was possible in all the patients. Frozen section confirmed the diagnosis and the quick parathormone assay (within 15 minutes) revealed a drop in parathormone levels to < 50% after excision in all of them. Three patients developed hypocalcaemia postoperatively and were treated with intravenous calcium supplementation. At a follow up of 2-29 months, all the patients were normocalcaemic. The renal functions improved in 2 of 6 patients who had renal failure.

CONCLUSION

Minimally invasive radioguided excision of parathyroid adenomas is a simple, safe and effective technique associated with a low morbidity and can be done as a day-care procedure.

Is there a role for estrogen and progesterone receptors in gall bladder cancer?

BACKGROUND/AIMS

The concept of metaplastic and non-metaplastic types of gall bladder cancer and the likelihood of hormone receptor expression in the nuclei of tumour cells raised the possibility of a potential role for anti-estrogen therapy in gall bladder cancer. This study was carried out to determine the hormone receptors (ER/PR) expression level in gall bladder cancer using specific immunohistochemical assays and correlate it with patient and tumour histopathological characteristics.

PATIENTS AND METHODS

Histopathological tumour specimens of 62 patients who underwent a radical cholecystectomy were analysed. Pronase pretreatment and primary monoclonal antibodies were used to perform immunohistochemical analysis for ER and PR.

RESULTS

The histology was adenocarcinoma--predominantly, moderately to poorly differentiated (91%). Gallstones were present in 90% of the individuals. Of the 62 specimens analysed, 62 (100%) and 61 (98%) were negative for ER and PR, respectively.

CONCLUSION

The high incidence of gallstone-related gall bladder cancer in India is associated with metaplasia and a tendency to poorer differentiation in the tumour histology. These tumours are consequently less likely to express hormone receptors. Thus, there does not seem to be a role for anti-hormone therapy in patients with histogenesis similar to that seen in India.

Comparative evaluation of Löwenstein-Jensen proportion method, BacT/ALERT 3D system, and enzymatic pyrazinamidase assay for pyrazinamide susceptibility testing of Mycobacterium tuberculosis

Pyrazinamide (PZA) is an important first-line antituberculosis drug because of its sterilizing activity against semidormant tubercle bacilli. In spite of its very high in vivo activity, its in vitro activity is not apparent unless an acidic environment is available, which makes PZA susceptibility testing difficult by conventional methods. The present study was, therefore, planned to assess the performance of the colorimetric BacT/ALERT 3D system and compare the results with those from conventional tests, i.e., the Löwenstein-Jensen (LJ) proportion method (pH 4.85) and Wayne's pyrazinamidase (PZase) assay, using 107 clinical isolates. The concordance among all of these tests was 89.71% after the first round of testing and reached 92.52% after resolution of the discordant results by retesting. Prolonged incubation of the PZase tube for up to 10 days was found to increase the specificity of the PZase test. The concordances between LJ proportion and BacT/ALERT 3D, LJ proportion and the PZase assay, and BacT/ALERT 3D and the PZase assay were found to be 99.06%, 93.46%, and 92.52%, respectively. Using the LJ results as the gold standard, the sensitivities of BacT/ALERT 3D and the PZase assay were 100 and 82.85%, respectively, while the specificity was 98.61% for both of the tests. The difference between the sensitivities of BacT/ALERT 3D and the PZase assay was significant (P = 0.025). The mean turnaround times for the detection of resistant and susceptible results by BacT/ALERT 3D were 8.04 and 11.32 days, respectively. While the major limitations associated with the PZase assay and the LJ proportion method are lower sensitivity in previously treated patients and a longer time requirement, respectively, the BacT/ALERT 3D system was found to be rapid, highly sensitive, and specific.

Antihyperglycemic activity ofRhizophora apiculataBl. in rats

The article reveals the antihyperglycemic activity of the ethanolic extract of the roots of the Rhizophora apiculata in rats (GLM and STZ models). On further fractionation of the ethanolic extract into four fractions, the activity was localized in the chloroform and aqueous fractions. These on purification led to the isolation of 7 pure compounds--lupeol (1), oleanolic acid (2), beta-sitosterol (3), palmitic acid (4), beta-sitosterol-beta-D-glucoside (5), inositol (6), and pinitol (7). The inositol and pinitol, two of the pure compounds, showed promising activity in STZ model at 100 mg kg(-1) dose level.

Isolated unilateral cerebellar hypoplasia. A case report

Isolated cerebellar malformations are relatively rare CNS anomalies, when they do occur they are frequently symptomatic. Some cases of asymptomatic cerebellar malformations have been reported. Unilateral cerebellar hypoplasia is one such entity. We describe a case of unilateral cerebellar hypoplasia presenting with non-specific neurological complaints.

Rubrivivax benzoatilyticus sp. nov., an aromatic, hydrocarbon-degrading purple betaproteobacterium

A brown-coloured bacterium was isolated from photoheterotrophic (benzoate) enrichments of flooded paddy soil from Andhra Pradesh, India. On the basis of 16S rRNA gene sequence analysis, strain JA2(T) was shown to belong to the class Betaproteobacteria, related to Rubrivivax gelatinosus (99 % sequence similarity). Cells of strain JA2(T) are Gram-negative, motile rods with monopolar single flagella. The strain contained bacteriochlorophyll a and most probably the carotenoids spirilloxanthin and sphaeroidene, but did not have internal membrane structures. Intact cells had absorption maxima at 378, 488, 520, 590, 802 and 884 nm. No growth factors were required. Strain JA2(T) grew on benzoate, 2-aminobenzoate (anthranilate), 4-aminobenzoate, 4-hydroxybenzoate, phthalate, phenylalanine, trans-cinnamate, benzamide, salicylate, cyclohexanone, cyclohexanol and cyclohexane-2-carboxylate as carbon sources and/or electron donors. The DNA G+C content was 74.9 mol%. Based on DNA-DNA hybridization studies, 16S rRNA gene sequence analysis and morphological and physiological characteristics, strain JA2(T) is different from representatives of other photosynthetic species of the Betaproteobacteria and was recognised as representing a novel species, for which the name Rubrivivax benzoatilyticus sp. nov. is proposed. The type strain is JA2(T) (=ATCC BAA-35(T)=JCM 13220(T)=MTCC 7087(T)).

Co-infection by Semliki forest virus and malarial parasite modulates viral multipucation, pathogenesis and cytokines in mice

Environmental, technological and societal factors continue to have a dramatic effect on infectious diseases worldwide and are considered to be facilitating the emergence of several infectious diseases at a time. Co-infection with different species of viral and malaria infections are currently emerging problems of dual infection in the developing as well as developed countries. Understanding of interactions between the host, malaria and virus infection is of current concern and we have initiated studies to delineate the mechanisms involved during the progression of Semliki forest virus (SFV) and Plasmodium yoelii (P. yoelii) infection in mice. Enhanced virus multiplication and up-regulation of cytokine mRNA level in P. yoelii and SFV co-infected mice were observed on day 4 post-infection compared to respective controls. Collectively, our observations indicate that malaria infection may influence virus multiplication, pathogenesis and up-regulation of cytokine mRNA during co-infection in mice.

Impact of Positive Preoperative Surveillance Blood Cultures From Chronic Indwelling Catheters in Cadaveric Intestinal Transplant Recipients

Recurrent bloodstream infections are a common indication for intestinal transplantation (ITx). Often, clinical symptoms may be absent in the setting of bacteremia, especially in patients with chronic liver disease. This study investigated the incidence and impact of positive blood cultures (BCx) obtained from central venous catheters used for total parenteral nutrition (TPN) in asymptomatic patients immediately prior to cadaveric ITx. Of 13 consecutive patients transplanted between November 2003 and November 2004, 12 underwent preoperative surveillance BCx with four positives (33%). Isolates included Staphylococcus epidermidis (n = 2), methicillin-resistant Staphylococcus aureus, and Citrobacter freundii. All four patients with positive BCx displayed liver dysfunction at the time of transplant (> or = grade 2 fibrosis, total bilirubin >8.0 g/dL), three of whom were inpatients. In contrast, only three of eight nonbacteremic patients showed liver disease of comparable severity. Liver dysfunction and inpatient status at the time of transplant appear to predict positive blood cultures. Postoperative length of stay and time on the ventilator were significantly longer among bacteremic as compared with nonbacteremic patients, but there were no differences in intraoperative blood use, time to total parenteral nutrition independence, or operative time between bacteremic and nonbacteremic patients. Our study showed that occult bacteremia in asymptomatic pre-intestinal transplant patients was not uncommon and may increase postoperative morbidity. Preemptive removal of long-term central venous catheters should be considered prior to ITx.

Arsenic trioxide for treatment of myelodysplastic syndrome: An experience from India

13156

Background: Myelodysplastic Syndrome (MDS) is a heterogeneous group of clonal diseases of the haematopoietic stem cells. The hallmark of the disease is ineffective haematopoiesis characterized by dysplasia with incomplete maturation and progressive increase in the percentage of myeloblast. No standard treatment is currently available for MDS. The early clinical experience has confirmed the activity of arsenic trioxide in MDS. The drug is able to induce differentiation and apoptosis and to inhibit cell proliferation or angiogenesis. It has the potential to be active in tumour models in MDS. The preliminary result of ongoing studies conducted in patients with MDS suggests that arsenic trioxide produces haematological improvement including durable transfusion independence in 30% of patients. The aim of our study was to see the response of MDS with arsenic trioxide and to see the toxicity profile of arsenic trioxide in Asian Indian population. Methods: During period from July 2005 to December 2005 we selected consecutive 10 patients of MDS in Refractory Anaemia, Refractory anaemia with ringed sideroblasts, Refractory anaemia with blast excess, Refractory anaemia with blast excess in transformations and chronic myelo monocytic leukemia phases. All patients had performance status more than 60%, some karyotypic abnormalities & in cytopenic phase. Median age of the patients 65 years (range 42 to 70 years). All patients were treated with arsenic trioxide 10mg (Alkem/India) daily for 2 hours infusion 28 days. In 15 days interval 3 courses were repeated. Response assessments were done by haematological, cytogenetic & quality of life assessment. All patients were evaluated after 3 courses of arsenic trioxide. Result: Sixty percent (6 patients) patients had shown major haematological response, forty percent minor & twenty percent has major cytogenetic response. Twenty percent of the patients has disease progression where as 20% has stable disease. The only mild adverse effects were seen in forms of nausea, vomiting, diarrhea, abdominal pain & dermatitis in 30% of patients. Only one patient (10%) had QT prolongation in ECG. Conclusion: We concluded that arsenic trioxide is very useful drug in myelodysplastic syndrome. It is also well tolerated in Asian Indian Population.

No significant financial relationships to disclose.

Assessment of nutrition in cancer patients and its effect on treatment outcome—A study from a developing country

6125

Background: In developing countries one-third of the people suffer from mal-nutrition. It has been shown that a good nutritional status can reduce complications of treatment, strengthen the immune system and contribute to the patient’s general well being throughout treatment. A good nutritional status is therefore essential for optimal treatment of a cancer patient. The aim of our study was to see the nutritional status of cancer patients on diagnosis and effect of nutrition on outcome of therapy. Methods: In this study we prospectively analyzed the nutritional status of 500 cancer patients in Netaji Subhash Chandra Bose Cancer Research Institute, a tertiary cancer center of eastern India during period from January 2004 to December 2005. The age range of the patients was 19 years to 74 years (median age 46 years). The parameter analyzed were weight for age, total protein, serum albumin and mid arm circumference. The weight for age and mid arm circumference were taken as normal if they were between 3rd and 97th percentile curve of the growth chart recommended by the Indian Council of Medical Research. The albumin level and the total protein were considered normal if the value is equal to or more than 3gm% and 5.8gm%. Result: It was seen that total 120 patients (24%) were low weight for age and 100 patients (20%) had low mid arm circumference. Total 90 patients (18%) had low serum albumin while 130 patients (26%) were low serum protein. Low weight for age, low serum albumin and low mid arm circumference were significant factors in disease free survival and toxicity of chemotherapy (p value < .001) Conclusion: We conclude that mal-nutrition is a major finding in cancer patients in developing country like ours. The patient with mal-nutrition had less disease free survival and more toxicities during therapy as compared to well-nourished patients.

No significant financial relationships to disclose.

Pharmacokinetics of an oral VEGF receptor tyrosine kinase inhibitor (PTK787/ZK222584) in patients with myelodysplastic syndrome (MDS): Cancer and Leukemia Group B Study 10105

6573

Background: Angiogenesis may contribute to the pathophysiology of myelodysplastic syndromes (MDS). PTK787/ZK222584 (PTK/ZK; Novartis and Schering AG) inhibits vascular endothelial growth factor (VEGF), platelet derived growth factor (PDGF) and c-kit receptor tyrosine kinases. Methods: We evaluated early toxicity and pharmacokinetics in a Phase II trial of PTK/ZK in patients with MDS. Patients received PTK/ZK 1,250 mg orally once daily on 28-day courses until disease progression or unacceptable toxicity. A two compartment model with first order absorption and an inducible clearance was fit to serial concentration time data using a MAP Bayesian algorithm as implemented in ADAPT II software. Results: We report preliminary toxicity and pharmacokinetics on 56 of 80 pts enrolled between March 2004 and January 2005. The most common CTC grade ≥2 non-hematological toxicities observed were fatigue, nausea, vomiting, dizziness and ataxia. The initial area under the concentration-time curve (AUCinit) ranged from 25.5–423.1 mg*h/L (mean, 105 mg*h/L). The induced AUC (AUCind) ranged from 8.2–265.3 mg*h/L (mean, 56.2 mg*h/L). There was a significant decrease in drug exposure (Hodges-Lehmann Estimate 45.2 mg*h/L [95% CI=30.5,60.0]; Wilcoxon signed rank test p <0.0001), likely due to CYP3A4 auto-induction. However, there was no statistical correlation between AUCinit and AUCind for individual patients. Because of marked inter-individual heterogeneity observed in AUCinit and AUCind, we examined if drug exposure correlated with toxicity during the first 2 courses. On exploratory analyses, there was no relationship between pharmacokinetic parameters (AUCinit, AUCind or a function of both AUCs) and the occurrence or grade of non-hematological toxicities. Conclusions: Drug exposure declined significantly within 7–14 days after starting treatment with PTK/ZK. In this sample, there was no statistical evidence suggesting that variability in drug exposure was associated with non-hematological toxicities of PTK/ZK in patients with MDS.

No significant financial relationships to disclose.

Effect of wheat grass juice in supportive care of terminally ill cancer patients— A tertiary cancer centre experience from India

8634

Background: The solid content of juice made from wheat grass is 70% chlorophyll. Chlorophyll is often referred to as “The blood of plant life” and has almost the same chemical structure as haemoglobin. Chlorophyll cleanses the blood by improving the supply of oxygen to the circulatory system. Wheat grass is also a complete protein with about 30 enzymes, vitamins & minerals. Wheat grass juice has been proven over many years to benefit people in numerous ways, building the blood, restoring balance in the body, removing toxic metals from the cells, nourishing the liver & kidneys and restoring vitality. The aim of our study was to see the effect of wheat grass juice in terminally ill cancer patients to improve the quality of life. Methods: During period from January 2003 to December 2005 we selected 400 solid organ cancer patients in our palliative care unit of Netaji Subhash Chandra Bose Cancer Research Institute to see the effect of wheat grass on improvement of haemoglobin level, serum protein & performance status on terminally ill cancer patients. The age range of the patients was 22 year to 87 year (median age 42 years). The different types of cancers were Lung (25%), Breast (20%), Oesophagaus (11%), Colon (9%), Ovary (8%), Hepatocellular carcinoma (6%), Stomach (6%) and others (15%) respectively. We cultivated wheat grass in our campus. When the grasses were 5 days old we took the fresh leaves including roots and made fresh juice out of that and had given 30ml of juice to all our 400 cancer patients for continuous 6 months. Result: The mean levels of haemoglobin, Serum total protein, albumin and performance status were 8gm%, 5.4gm%, 2.2gm% and 50%. Fifty patients required transfusion support & those patients were excluded from the study. Other 348 patients are evaluated 6 months after giving wheat grass juice. The mean values for haemoglobin, total protein & albumin were improved significantly (pvalue < .005) and were observed mean of 9.6gm%, 7.4gm% and 3.1gm%. White blood cell & platelet count were same in both the cases. The performance status was improved from 50% to 70% (Karnofsky) after wheat grass treatment. Conclusion: We concluded that wheat grass juice is an effective alternative of blood transfusion. Its use in terminally ill cancer patients should be encouraged.

No significant financial relationships to disclose.

Ionizing radiation enhances therapeutic activity of mda-7/IL-24: overcoming radiation- and mda-7/IL-24-resistance in prostate cancer cells overexpressing the antiapoptotic proteins bcl-xL or bcl-2

Subtraction hybridization applied to terminally differentiating human melanoma cells identified mda-7/IL-24, a cytokine belonging to the IL-10 gene superfamily. Adenoviral-mediated delivery of mda-7/IL-24 (Ad.mda-7) provokes apoptosis selectively in a wide spectrum of cancers in vitro in cell culture, in vivo in human tumor xenograft animal models and in patients with advanced carcinomas and melanomas. In human prostate cancer cells, a role for mitochondrial dysfunction and induction of reactive oxygen species in the apoptotic process has been established. Ectopic overexpression of bcl-xL and bcl-2 prevents these changes including apoptosis induction in prostate tumor cells by Ad.mda-7. We now document that this resistance to apoptosis can be reversed by treating bcl-2 family overexpressing prostate tumor cells with ionizing radiation in combination with Ad.mda-7 or purified GST-MDA-7 protein. Additionally, radiation augments apoptosis induction by mda-7/IL-24 in parental and neomycin-resistant prostate tumor cells. Radiosensitization to mda-7/IL-24 is dependent on JNK signaling, as treatment with the JNK 1/2/3 inhibitor SP600125 abolishes this effect. Considering that elevated expression of bcl-xL and bcl-2 are frequent events in prostate cancer development and progression, the present studies support the use of ionizing radiation in combination with mda-7/IL-24 as a means of augmenting the therapeutic benefit of this gene in prostate cancer, particularly in the context of tumors displaying resistance to radiation therapy owing to bcl-2 family member overexpression.

Structural and functional outcome of scleral patch graft

PURPOSE

To evaluate the visual and structural outcomes of scleral patch grafting in cases of scleral defect.

METHODS

The study was a retrospective interventional case series. Medical records of all patients who underwent scleral patch grafting at a tertiary care centre between 1997 and 2003 for scleral defects were reviewed. After removal of all the devitalized tissue, alcohol-preserved full-thickness sclera was tailored to fit the defect and sutured in place. The graft was covered with a conjunctival flap or amniotic membrane. Structural integrity and visual outcome were assessed as the main outcome measures.

RESULTS

A total of 13 eyes of 13 patients required scleral patch grafting for scleral defects of varying aetiologies, the most common being necrotizing scleritis following pterygium surgery (40%). The patients were followed up for 6-60 months, an average period of 24.3 months. Tectonic success was achieved in 10 eyes (76.9%). Three complications were noted: endophthalmitis, graft necrosis, and graft dehiscence with uveal prolapse. However, no regrafts were needed. Epithelialization and vascularization were seen in the remaining eyes after an average duration of 3-4 weeks. Visual acuity remained stable in the majority (9/13, 60%), improved in one and deteriorated in three eyes.

CONCLUSIONS

Scleral grafting with overlying conjunctival or amniotic membrane graft is an effective and simple measure for preserving globe integrity both structurally and functionally.

Activation of Ras/Raf protects cells from melanoma differentiation-associated gene-5-induced apoptosis

Melanoma differentiation-associated gene-5 (mda-5) was the first molecule identified in nature whose encoded protein embodied the unique structural combination of an N-terminal caspase recruitment domain and a C-terminal DExD/H RNA helicase domain. As suggested by its structure, cumulative evidences documented that ectopic expression of mda-5 leads to growth inhibition and/or apoptosis in various cell lines. However, the signaling pathways involved in mda-5-mediated killing have not been elucidated. In this study, we utilized either genetically modified cloned rat embryo fibroblast cells overexpressing different functionally and structurally distinct oncogenes or human pancreatic and colorectal carcinoma cells containing mutant active ras to resolve the role of the Ras/Raf signaling pathway in mda-5-mediated growth inhibition/apoptosis induction. Rodent and human tumor cells containing constitutively activated Raf/Raf/MEK/ERK pathways were resistant to mda-5-induced killing and this protection was antagonized by intervening in this signal transduction cascade either by directly inhibiting ras activity using an antisense strategy or by targeting ras-downstream factors, such as MEK1/2, with the pharmacological inhibitor PD98059. The present findings provide a further example of potential cross-talk between growth-inhibitory and growth-promoting pathways in which the ultimate balance of these factors defines cellular homeostasis, leading to survival or induction of programmed cell death.