Oral manifestations in HIV/AIDS infected patients from India

OBJECTIVES

To assess types and prevalence of HIV-related oral lesions among HIV-infected individuals in south India and to correlate common oral findings with co-morbidities, gender, age and medication.

SUBJECTS AND METHODS

One hundred and one patients with HIV infection or AIDS at infectious diseases units of Attavar Hospital, Mangalore, and medical wards of Kasturba Medical College, Manipal, were selected. Sociodemographic information was obtained using a structured questionnaire. Oral lesions were diagnosed according to the presumptive criteria of EEC-Clearinghouse Classification. Clinical history was retrieved from patient's medical records.

RESULTS

Erythematous candidiasis (44.5%), melanotic hyperpigmentaion (34.6%) and xerostomia (29.7%) were among the most common oral manifestations. A significant association was found between oral candidiasis and advanced immunosuppression (P < 0.05). Oral hairy leukoplakia (OHL) was predominant in individuals <35 years (P < 0.05). Melanotic hyperpigmentation was significantly associated with highly active antiretroviral therapy (P < 0.05). OHL was more frequent in patients with HIV-associated tuberculosis. Linear gingival erythema was more predominant in females.

CONCLUSIONS

Oral hairy leukoplakia showed a positive relationship with patients younger than 35 years. Oral candidiasis can act as a marker for immunosuppression. Angular cheilitis was predominant in the symptomatic stage.

Local image registration by adaptive filtering

We propose a new adaptive filtering framework for local image registration, which compensates for the effect of local distortions/displacements without explicitly estimating a distortion/displacement field. To this effect, we formulate local image registration as a two-dimensional (2-D) system identification problem with spatially varying system parameters. We utilize a 2-D adaptive filtering framework to identify the locally varying system parameters, where a new block adaptive filtering scheme is introduced. We discuss the conditions under which the adaptive filter coefficients conform to a local displacement vector at each pixel. Experimental results demonstrate that the proposed 2-D adaptive filtering framework is very successful in modeling and compensation of both local distortions, such as Stirmark attacks, and local motion, such as in the presence of a parallax field. In particular, we show that the proposed method can provide image registration to: a) enable reliable detection of watermarks following a Stirmark attack in nonblind detection scenarios, b) compensate for lens distortions, and c) align multiview images with nonparametric local motion.

Dural venous thrombosis - A neglected finding on routine MRI sequences

Objectives - To establish the role of routine MR sequences in diagnosis of dural venous sinus thrombosis. Materials and Methods - As dural venous sinus thrombosis has a non specific presentation, all the patients coming to our department for MRI head between March 2003 and May 2005 were looked for abnormal signal intensity within the dural sinuses. Twenty seven cases having loss of normal flow void within the major dural venous sinuses on routine sequences (FSE T2, SE T1 & FLAIR) were thought of having dural sinus thrombosis and so were further evaluated by MR venography. This study was carried out using 0.2 Tesla open magnet MR scanner (GE signa profile 4). Results - On routine MR sequences absence of dural sinus flow void was noted in twenty seven patients and suspicion of cerebral venous thrombosis was raised. The diagnosis of thrombosis was confirmed in twenty three patients by 2-D TOF MR venography and no thrombosis could be demonstrated in remaining four patients. Thirteen patients had multiple sinus involved whereas in ten patients only single sinus was involved. Out of these twenty three patients, apart from thrombosis, six had infarcts, three had mastoiditis and one of them had cerebellar abscess too. Hemorrhage was noted in five patients and the most interesting fact was that nine patients had normal brain parenchyma. Conclusion - Dural venous sinus thrombosis appears as loss of normal flow void on routine sequences especially on FSE T2W and FLAIR images. This fact may help us suspect DVT, and the finding can be confirmed by MR venography so that further management can be planned promptly.

Lossless watermarking for image authentication: a new framework and an implementation

We present a novel framework for lossless (invertible) authentication watermarking, which enables zero-distortion reconstruction of the un-watermarked images upon verification. As opposed to earlier lossless authentication methods that required reconstruction of the original image prior to validation, the new framework allows validation of the watermarked images before recovery of the original image. This reduces computational requirements in situations when either the verification step fails or the zero-distortion reconstruction is not needed. For verified images, integrity of the reconstructed image is ensured by the uniqueness of the reconstruction procedure. The framework also enables public(-key) authentication without granting access to the perfect original and allows for efficient tamper localization. Effectiveness of the framework is demonstrated by implementing the framework using hierarchical image authentication along with lossless generalized-least significant bit data embedding.

Current trend of poisoning--a hospital profile

A one-year study was carried out among the poisoning cases admitted in the emergency wing of Guru Nanak Dev Hospital attached to Government Medical College, Amritsar during the period from 10-5-1997 to 9-5-1998. Out of 10,664 admitt emergencies, 3.19% were poisoning cases. Male to female ratio was nearly 3:1. Majority (45.59%) of the victims were in the age group of 21-30 years, 69.12% were married and 51.47% belonged to urban area. At the time of admission 61.47% cases were conscious, 26.17% were partially conscious and 12.36% were unconscious. Majority (76.47%) of the victims committed suicide, in 20.88% cases manner of death was accident and homicide was reported in 1.76% cases. Commones poison was aluminium phosphide (38.23%) followed by organophosphorus compounds (17.64%). The study observed increasing trend of suicide by aluminium phosphide and organophosphorus compounds, whereas other poisons for committing suicide were less commonly used.

Attenuation of protein adsorption on static and oscillating magnetostrictive nanowires

The research described here investigates the hypothesis that nanoarchitecture contained in a nanowire array is capable of attenuating the adverse host response generated when medical devices are implanted in the body. This adverse host response, or biofouling, generates an avascular fibrous mass transfer barrier between the device and the analyte of interest, disabling the implant if it is a sensor. Numerous studies have indicated that surface chemistry and architecture modulate the host response. These findings led us to hypothesize that nanostructured surfaces will inhibit the formation of an avascular fibrous capsule significantly. We are investigating whether arrays of oscillating magnetostrictive nanowires can prevent protein adsorption. Magnetostrictive nanowires were fabricated by electroplating a ferromagnetic metal alloy into the pores of a nanoporous alumina template. The ferromagnetic nanowires are made to oscillate by oscillating the magnetic field surrounding the wires. Radiolabeled bovine serum albumin, enzyme-linked immunosorbent assay (ELISA), and other protein assays were used to study protein adhesion on the nanowire arrays. These results display a reduced protein adsorption per surface area of static nanowires. Comparing the surfaces, 14-30% of the protein that absorbed on the flat surface adsorbed on the nanowires. Our contact angle measurements indicate that the attenuation of protein on the nanowire surface might be due to the increased hydrophilicity of the nanostructured surface compared to a flat surface of the same material. We oscillated the magnetostrictive wires by placing them in a 38 G 10 Hz oscillating magnetic field. The oscillating nanowires show a further reduction in protein adhesion where only 7-67% of the protein on the static wires was measured on the oscillating nanowires. By varying the viscosity of the fluid the nanowires are oscillated in, we determined that protein detachment is shear-stress modulated. We created a high shearing fluid with dextran, which reduced protein adsorption on the oscillating nanowires by 70% over nanowires oscillating in baseline viscosity fluid. Our preliminary studies strongly suggest that the architecture in the static nanowire arrays and the shear created by oscillating the nanowire arrays would attenuate the biofouling response in vivo.

Two-dimensional transforms for device color correction and calibration

Color device calibration is traditionally performed using one-dimensional (1-D) per-channel tone-response corrections (TRCs). While 1-D TRCs are attractive in view of their low implementation complexity and efficient real-time processing of color images, their use severely restricts the degree of control that can be exercised along various device axes. A typical example is that per separation (or per-channel), TRCs in a printer can be used to either ensure gray balance along the C = M = Y axis or to provide a linear response in delta-E units along each of the individual (C, M, and Y) axis, but not both. This paper proposes a novel two-dimensional color correction architecture that enables much greater control over the device color gamut with a modest increase in implementation cost. Results show significant improvement in calibration accuracy and stability when compared to traditional 1-D calibration. Superior cost quality tradeoffs (over 1-D methods) are also achieved for emulation of one color device on another.

A retrospective analysis of open globe injuries in a tertiary ophthalmological centre in North-East India

PURPOSE

To evaluate the clinical presentations and surgical outcome in patients with open globe injuries in a tertiary ophthalmological centre in North-east India.

METHODS

Case sheets of 79 patients undergoing surgery following open globe injuries at Sri Sankaradeva Nethralaya, Guwahati were studied retrospectively in terms of the type of injury, surgical interventions and final visual outcome. The period of study was from 1994-2005.

RESULTS

Injury was mild in 48 (60.8%), moderate in 17 (21.5%) & severe in 14 (17.7%) cases (International Ocular Trauma Classification). 46 (58.2%) cases had only primary repair, 27 (34.2%) had associated lens extraction, 12 (15.2%) had vitrectomy, 2 (2.5%) had retinal detachment surgery, one (1.3%) had intra-ocular foreign body removal, one (1.3%) evisceration.13 (16.5%) cases underwent secondary procedures. Final vision was 6\18 or better in 20 (25.3%), 6\18-6\60 in 14 (17.7%) and <6\60 in 15 (18.9%) cases. 10 (12.7%) cases developed phthisical changes.

CONCLUSION

Present analysis reveals that open globe injuries can present in varying severity & though the overall prognosis is grave, prompt surgical intervention can result in better visual outcome.

Lossless generalized-lSB data embedding

We present a novel lossless (reversible) data-embedding technique, which enables the exact recovery of the original host signal upon extraction of the embedded information. A generalization of the well-known least significant bit (LSB) modification is proposed as the data-embedding method, which introduces additional operating points on the capacity-distortion curve. Lossless recovery of the original is achieved by compressing portions of the signal that are susceptible to embedding distortion and transmitting these compressed descriptions as a part of the embedded payload. A prediction-based conditional entropy coder which utilizes unaltered portions of the host signal as side-information improves the compression efficiency and, thus, the lossless data-embedding capacity.

Anti-diabetic activity and mechanism of action of chromium chloride

Though supplementation of chromium has been found to improve deranged carbohydrate and lipid metabolism associated with suboptimal chromium intake in patients, its usefulness in the treatment of diabetes mellitus of variable etiology remains questionable. In the present investigation, the effect of 6 wk oral administration of chromium chloride (CC) on the glucose and lipid metabolism was studied in streptozotocin (STZ) diabetic and neonatal-STZ (nSTZ) diabetic rats. Further, its cellular mechanism was studied using 3T3-L1 adipocyte and C2C12 myoblast cell lines. Treatment with CC significantly improved the impaired glucose tolerance and insulin sensitivity of both STZ diabetic and nSTZ diabetic rats without any change in basal or glucose stimulated insulin response indicating insulin-sensitizing action of chromium. CC treatment also significantly improved deranged lipid metabolism. CC per se did not produce any effect in vitro, however, significantly increased insulin stimulated glucose uptake in C2C12 myoblasts and differentiation of 3T3-L1 preadipocytes into mature adipocytes supporting the in vivo insulin-sensitizing action of chromium. This study shows that CC exhibited significant anti-diabetic potential in chemically-induced diabetes in rats, the mechanism of which appears to be potentiation of insulin actions at the target tissues leading to improved peripheral insulin sensitivity.

Eruption disturbances: an aetiological-cum-management perspective

Failure of permanent teeth to erupt without any known cause is a rare incident. We report a case of multiple unerupted permanent teeth and make an effort to predict all possible causes of non-eruption of permanent teeth clinically and radiographically. It is essential to diagnose and treat eruption disturbances as early as possible because treatment at a later stage is usually more complicated due to the tendency of malocclusion to increase with time and reduced ability of remaining dentition to adjust.

Synthesis and characterization of extremely uniform Fe-Co-Ni ternary alloy nanowire arrays

We have fabricated extremely uniform arrays of polycrystalline Fe-Co-Ni ternary alloy nanowires having composition Fe 12.3 wt.%, Co 43.9 wt.% and Ni 43.8 wt.%. The wires are made by electrodeposition into nanoporous alumina templates, using an electrodeposition voltage of 15 V at 1000 Hz. Nanowires have been fabricated having diameters ranging from 43 nm to 120 nm, and lengths of 3 microm to 7 microm, as dependent upon template topology. The magnetization easy axis lies along the nanowire length, with an easy axis coercivity of 72 kA/m.

First-trimester screening for aneuploidy with fetal nuchal translucency in a United States population

OBJECTIVE

To examine the detection rate of chromosomal abnormalities using a combination of nuchal translucency (NT) and maternal age in a United States population.

METHODS

A total of 2131 pregnancies with 2339 fetuses underwent NT screening from April 2000 to April 2002 in our ultrasound unit. Nuchal translucency was measured from 11 to 14 weeks' gestation. Fetal crown-rump length (CRL) was also measured. The risk for trisomy 21 was calculated from a combination of maternal age and fetal NT with the use of software provided by The Fetal Medicine Foundation (FMF). Sensitivity and false-positive rates were calculated for different risk cut-offs.

RESULTS

Chromosomal defects were diagnosed in 32 cases, including 12 cases of trisomy 21 and 10 cases of trisomy 18. The estimated risk based on maternal age and fetal NT was 1 in 300 or greater in 195 (8.3%) cases and these included 10/12 (83.3%) pregnancies with trisomy 21 and 9/10 (90.0%) pregnancies with trisomy 18.

CONCLUSION

A combination of maternal age and fetal NT provides an effective method of screening for chromosomal defects. Using ultrasound techniques and risk algorithms from The FMF, the performance of the test in an American population is similar to that described in international populations.

Incidence of Wound Infection after cholecystectomy with or without appendicectomy

From the 1st of September 1978 to the end of August 1979 one hundred and one patients undrewent laprotomy for gall-stones and gall-bladder diseases in the Department of Surgery, Bir Hospital, All operations were performed by one team. Among-them seventeen were males (16.8%) and eighty four females (83.2%). Cholecystectomy and appendicectomy were performed in fortyseven patients, among them nine patients underwent choledochotomy as well. Postoperative wound infection after cholecystectomy. cholecystectomy with choledochotomy and removal of the gall bladder with appendicectomy was 5.9, 10 and 10.6 percent respectively. Despite high incidence of wound sepsis after biliary surgery with appendicectomy the later procedure is advocated during routine cholecystectomy, because there are very few hospitals in Nepal where facilities for laparotomy exist, and review of English literature has revealed a number of references to concomitant cholecystic - appendiceal disease. These reports refer to the high incidence of unsuspected pathological process within the appendex as a indication for its removal at the time of elective cholecystectomy.

Thyroid hormones levels in infants during and after cardiopulmonary bypass with ultrafiltration

OBJECTIVE

The aim of this study was to find out if infants after cardiopulmonary bypass develop non-thyroidal illness and if illness severity after cardiopulmonary bypass depends on hormone concentration in ultrafiltrate.

METHODS

Thyroid hormone status was assessed in 20 infants with congenital heart defects undergoing cardiac surgery (age range 7 days-11 months). Blood samples were collected preoperatively, during cardiopulmonary bypass, after cardiopulmonary bypass, and also postoperatively in 1, 2, 3, and 8 day after cardiac surgery. Plasma thyrotropin, thyroxine, free thyroxine, triiodothyronine, free triiodothyronine and reverse triiodothyronine were measured in blood samples and also in ultrafiltrate.

RESULTS

All patients had reduction in serum thyrotropin, thyroxine, free thyroxine, triiodothyronine, free triiodothyronine, and elevation of reverse triiodothyronine after cardiac surgery. In all patients we performed ultrafiltration. Patients were divided in to two groups. (with and without prolonged recovery). In the group of patients with prolonged recovery we noticed significantly higher amount of triiodothyronine per kilogram body weight. One of these patients died. The average level of total thyroxine decreased from the level 126 nmol/l before bypass to the minimal level 73 nmol/l after bypass, free thyroxine from the level 18 pmol/l before bypass to the minimal level 12 pmol/l after bypass. The average level of total triiodothyronine decreased from the level 1.54 nmol/l before bypass to the minimal level 0.42 nmol/l after bypass, free triiodothyronine from the level 6.12 pmol/l before bypass to the minimal level 3.21 pmol/l after bypass. The average level of TSH decreased from the level 4.31 mU/l before bypass to the level 0.64 mU/l after bypass. The average level of reverse-triiodothyronine increase from the level 0.83 nmol/l before bypass to the maximal level 1.94 nmol/l after bypass.

CONCLUSIONS

We conclude that non-thyroidal illness occurs in all infants after cardiopulmonary bypass. The amount of free triiodothyronine that is filtrated during cardiopulmonary bypass may influence postoperative recovery.

Hierarchical watermarking for secure image authentication with localization

Several fragile watermarking schemes presented in the literature are either vulnerable to vector quantization (VQ) counterfeiting attacks or sacrifice localization accuracy to improve security. Using a hierarchical structure, we propose a method that thwarts the VQ attack while sustaining the superior localization properties of blockwise independent watermarking methods. In particular, we propose dividing the image into blocks in a multilevel hierarchy and calculating block signatures in this hierarchy. While signatures of small blocks on the lowest level of the hierarchy ensure superior accuracy of tamper localization, higher level block signatures provide increasing resistance to VQ attacks. At the top level, a signature calculated using the whole image completely thwarts the counterfeiting attack. Moreover, "sliding window" searches through the hierarchy enable the verification of untampered regions after an image has been cropped. We provide experimental results to demonstrate the effectiveness of our method.

Temperature stability of vaginal specimens for Chlamydia trachomatis detection by Amplicor polymerase chain reaction assay

Vaginal introital specimens were collected from 17 women - 10 positive and 7 negative for Chlamydia trachomatis, and kept in Amplicor collection medium at ambient temperature. Aliquots were removed at intervals for up to 34 days and frozen at -80 degrees C. Samples were thawed and assayed for C. trachomatis by polymerase chain reaction (PCR). The results of all specimens remained unchanged over this time interval.

Nicotinic cholinergic signaling in hippocampal astrocytes involves calcium-induced calcium release from intracellular stores

In this report we provide evidence that neuronal nicotinic acetylcholine receptors (nAChRs) are present on hippocampal astrocytes and their activation produces rapid currents and calcium transients. Our data indicate that these responses obtained from astrocytes are primarily mediated by an AChR subtype that is functionally blocked by alpha-bungarotoxin (alpha Bgt) and contains the alpha7 subunit (alpha Bgt-AChRs). Furthermore, their action is unusual in that they effectively increase intracellular free calcium concentrations by activating calcium-induced calcium release from intracellular stores, triggered by influx through the receptor channels. These results reveal a mechanism by which alpha Bgt-AChRs on astrocytes can efficiently modulate calcium signaling in the central nervous system in a manner distinct from that observed with these receptors on neurons.

Development of Dot-ELISA for the detection of human rotavirus antigen and comparison with RNA-PAGE

AIMS

Development of a simple, specific, rapid and inexpensive Dot-ELISA test for diagnosis of rotaviral antigen in stool samples.

METHODS AND RESULTS

Hyperimmune rabbit antisera raised against SA-11 (Simian Agent-11) strain was used as primary antibody. The secondary antibody conjugate used was the goat anti-rabbit IgG alkaline phosphatase, and BCIP/NBT solution was used as substrate. Faecal extracts were diluted 10-fold and used for the detection of rotavirus antigen. RNA-PAGE was performed to compare the specificity and sensitivity of the diagnostic tests. Dot-ELISA positive samples were further confirmed by Western blot analysis.

CONCLUSIONS

This Dot-ELISA test could be used as an alternative method for diagnosing rotaviral samples in the field.

SIGNIFICANCE AND IMPACT OF THE STUDY

The Dot-ELISA test is simple, specific, rapid and cost effective. It is suitable for identifying a large number of samples obtained from epidemiological studies and hence, reducing the death rate of rotavirus-infected patients.

Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial

CONTEXT

Patients with chronic fatigue syndrome (CFS) are more likely than healthy persons to develop neurally mediated hypotension (NMH) in response to prolonged orthostatic stress.

OBJECTIVE

To examine the efficacy of fludrocortisone acetate as monotherapy for adults with both CFS and NMH.

DESIGN

Randomized, double-blind, placebo-controlled trial conducted between March 1996 and February 1999.

SETTING

Two tertiary referral centers in the United States.

PATIENTS

One hundred individuals aged 18 to 50 years who satisfied Centers for Disease Control and Prevention criteria for CFS and had NMH provoked during a 2-stage tilt-table test. Eighty-three subjects had adequate outcome data to assess efficacy.

INTERVENTION

Subjects were randomly assigned to receive fludrocortisone acetate, titrated to 0.1 mg/d (n = 50) or matching placebo (n = 50) for 9 weeks, followed by 2 weeks of observation after discontinuation of therapy.

MAIN OUTCOME MEASURE

Proportion of subjects in each group with at least a 15-point improvement on a 100-point global wellness scale.

RESULTS

Baseline demographic and illness characteristics between the groups were similar; CFS had been present for at least 3 years in 71%. Using an intention-to-treat analysis, 7 subjects (14%) treated with fludrocortisone experienced at least a 15-point improvement in their wellness scores compared with 5 (10%) among placebo recipients (P =.76). No differences were observed in several other symptom scores or in the proportion with normal follow-up tilt test results at the end of the treatment period.

CONCLUSIONS

In our study of adults with CFS, fludrocortisone as monotherapy for NMH was no more efficacious than placebo for amelioration of symptoms. Failure to identify symptomatic improvement with fludrocortisone does not disprove the hypothesis that NMH could be contributing to some of the symptoms of CFS. Further studies are needed to determine whether other medications or combination therapy are more effective in treating orthostatic intolerance in patients with CFS.

Show-through cancellation in scans of duplex printed documents

In scanning pages with double-sided printing, often the printing on the back-side shows through in the scan of the front-side because the paper is not completely opaque. This show-through is an undesirable artifact that one would like to remove. In this paper, the phenomenon of show-through is analyzed using first physical principles to obtain a simplified mathematical model. The model is linearized using suitable transformations and simplifying approximations. Based on the linearized model, an adaptive linear filtering scheme is developed for the electronic removal of show-through using scans of both sides of the document. Experimental results demonstrating the effectiveness of the method developed are presented.

Genetic lesions of bilirubin uridine-diphosphoglucuronate glucuronosyltransferase (UGT1A1) causing Crigler-Najjar and Gilbert syndromes: correlation of genotype to phenotype

Uridine-diphosphoglucuronate glucuronosyltransferases (UGTs) are a family of enzymes that conjugate various endogenous and exogenous compounds with glucuronic acid and facilitate their excretion in the bile. Bilirubin-UGT(1) (UGT1A1) is the only isoform that significantly contributes to the conjugation of bilirubin. Lesions in the gene encoding bilirubin-UGT(1), lead to complete or partial inactivation of the enzyme causing the rare autosomal recessively inherited conditions, Crigler-Najjar syndrome type-1 (CN-1) and type 2 (CN-2), respectively. Inactivation of the enzyme leads to accumulation of unconjugated bilirubin in the serum. Severe hyperbilirubinemia seen in CN-1 can cause bilirubin encephalopathy (kernicterus). Kernicterus can be fatal or may leave behind permanent neurological sequelae. Here, we have compiled more than 50 genetic lesions of UGT1A1 that cause CN-1 (including 9 novel mutations) or CN-2 (including 3 novel mutations) and have presented a correlation of structure to function of UGT1A1. In contrast to Crigler-Najjar syndromes, Gilbert syndrome is a common inherited condition characterized by mild hyperbilirubinemia. An insertional mutation of the TATAA element upstream to UGT1A1 results in a reduced level of expression of the gene. Homozygosity for the variant promoter is required for Gilbert syndrome, but not sufficient for manifestation of hyperbilirubinemia, which is partly dependent on the rate of bilirubin production. Several structural mutations of UGT1A1, for example, a G71R substitution, have been reported to cause mild reduction of UGT activity toward bilirubin, resulting in mild hyperbilirubinemia, consistent with Gilbert syndrome. When the normal allele of a heterozygote carrier for a Crigler-Najjar type structural mutation contains a Gilbert type promoter, intermediate levels of hyperbilirubinemia, consistent with the diagnosis of CN-2, may be observed.

Genetic lesions of bilirubin uridine-diphosphoglucuronate glucuronosyltransferase (UGT1A1) causing Crigler-Najjar and Gilbert syndromes: correlation of genotype to phenotype

Uridine-diphosphoglucuronate glucuronosyltransferases (UGTs) are a family of enzymes that conjugate various endogenous and exogenous compounds with glucuronic acid and facilitate their excretion in the bile. Bilirubin-UGT(1) (UGT1A1) is the only isoform that significantly contributes to the conjugation of bilirubin. Lesions in the gene encoding bilirubin-UGT(1), lead to complete or partial inactivation of the enzyme causing the rare autosomal recessively inherited conditions, Crigler-Najjar syndrome type-1 (CN-1) and type 2 (CN-2), respectively. Inactivation of the enzyme leads to accumulation of unconjugated bilirubin in the serum. Severe hyperbilirubinemia seen in CN-1 can cause bilirubin encephalopathy (kernicterus). Kernicterus can be fatal or may leave behind permanent neurological sequelae. Here, we have compiled more than 50 genetic lesions of UGT1A1 that cause CN-1 (including 9 novel mutations) or CN-2 (including 3 novel mutations) and have presented a correlation of structure to function of UGT1A1. In contrast to Crigler-Najjar syndromes, Gilbert syndrome is a common inherited condition characterized by mild hyperbilirubinemia. An insertional mutation of the TATAA element upstream to UGT1A1 results in a reduced level of expression of the gene. Homozygosity for the variant promoter is required for Gilbert syndrome, but not sufficient for manifestation of hyperbilirubinemia, which is partly dependent on the rate of bilirubin production. Several structural mutations of UGT1A1, for example, a G71R substitution, have been reported to cause mild reduction of UGT activity toward bilirubin, resulting in mild hyperbilirubinemia, consistent with Gilbert syndrome. When the normal allele of a heterozygote carrier for a Crigler-Najjar type structural mutation contains a Gilbert type promoter, intermediate levels of hyperbilirubinemia, consistent with the diagnosis of CN-2, may be observed.

Genetic lesions of bilirubin uridine-diphosphoglucuronate glucuronosyltransferase (UGT1A1) causing Crigler-Najjar and Gilbert syndromes: correlation of genotype to phenotype

Uridine-diphosphoglucuronate glucuronosyltransferases (UGTs) are a family of enzymes that conjugate various endogenous and exogenous compounds with glucuronic acid and facilitate their excretion in the bile. Bilirubin-UGT(1) (UGT1A1) is the only isoform that significantly contributes to the conjugation of bilirubin. Lesions in the gene encoding bilirubin-UGT(1), lead to complete or partial inactivation of the enzyme causing the rare autosomal recessively inherited conditions, Crigler-Najjar syndrome type-1 (CN-1) and type 2 (CN-2), respectively. Inactivation of the enzyme leads to accumulation of unconjugated bilirubin in the serum. Severe hyperbilirubinemia seen in CN-1 can cause bilirubin encephalopathy (kernicterus). Kernicterus can be fatal or may leave behind permanent neurological sequelae. Here, we have compiled more than 50 genetic lesions of UGT1A1 that cause CN-1 (including 9 novel mutations) or CN-2 (including 3 novel mutations) and have presented a correlation of structure to function of UGT1A1. In contrast to Crigler-Najjar syndromes, Gilbert syndrome is a common inherited condition characterized by mild hyperbilirubinemia. An insertional mutation of the TATAA element upstream to UGT1A1 results in a reduced level of expression of the gene. Homozygosity for the variant promoter is required for Gilbert syndrome, but not sufficient for manifestation of hyperbilirubinemia, which is partly dependent on the rate of bilirubin production. Several structural mutations of UGT1A1, for example, a G71R substitution, have been reported to cause mild reduction of UGT activity toward bilirubin, resulting in mild hyperbilirubinemia, consistent with Gilbert syndrome. When the normal allele of a heterozygote carrier for a Crigler-Najjar type structural mutation contains a Gilbert type promoter, intermediate levels of hyperbilirubinemia, consistent with the diagnosis of CN-2, may be observed.

Symptomatic human rotavirus subgroups, serotypes & electropherotypes in Hyderabad, India

A total of 352 stool specimens obtained from children under 2 yr of age with acute diarrhoea, between January 1998 and March 1999, were screened for the presence of rotavirus by RNA-PAGE. Symptomatic human rotaviruses were detected in 57 of 352 (16.19%) specimens by RNA-PAGE. These 57 samples were tested for rotavirus double stranded RNA pattern and among these, 46 samples were tested for subgroup and serotype specificities. Among the 46 strains tested, 29 strains were found to be subgroup II and remaining 17 strains were subgroup I, indicating that subgroup II strains are more predominant than subgroup I strains. Subgroup I and II strains were circulating concurrently throughout the study period. Seventeen strains with 'short' RNA pattern and subgroup I specificity could not be assigned as serotype 2 strains as they exhibited cross-reactivity to MAbs specific for more than one serotype. Of the 29 subgroup II strains with 'long' RNA pattern, 16 (55.17%) were serotype 1, 8 (27.58%) were serotype 4. Five (17.24%) showed dual reactivity to serotypes 1 and 3. Our results indicated that serotype 1 and G2-like strains are predominant in Hyderabad. None of the virus strains showed an unusual RNA pattern.

Detection of influenza virus induced DNA damage by comet assay

Influenza virus A2/HK/68 is known to be a biological mutagen and teratogen. Reports are available implicating influenza virus as a causative agent of chromosomal aberrations in cells in culture and also in circulating leukocytes of humans. Also, an increased incidence of abortions, prenatal mortality and congenital abnormalities during the periods of epidemics has also been reported. In view of these reports, it would be worthwhile to screen persons especially pregnant women exposed to influenza virus for possible DNA damage. The present study reports the use of Comet assay to measure influenza virus induced DNA damage. We have carried out in vitro infection experiments using human leukocytes. Our results clearly indicate that influenza virus A2/HK/68 induces DNA damage in leukocytes right from 2-h post-infection. Maximum damage was observed at 24-h post-infection. However, at 48-h post-infection, a slight decrease was observed which can be attributed to the DNA repair occurring in the cells. Thereafter, irreparable damage was noticed. Cell viability results have shown lack of cytotoxicity till 72-h post-infection. However, significant cytotoxicity was observed only at 96-h post-infection. The occurrence of DNA damage without cell death may result in chromosomal aberrations or mutations. Therefore, it is most advisable to get screened for the possible DNA damage especially persons frequently infected with influenza and pregnant women.

Evaluation of a new recombinant DNA hepatitis B vaccine (Shanvac-B)

We assessed the efficacy and safety of Shanvac-B, a new recombinant hepatitis B vaccine developed in India. Eighty-one healthy volunteers (75 women, 6 men; aged 18-40 yr), negative for markers for hepatitis B and HIV, received 20 microg of the vaccine intramuscularly at 0, 1 and 2 months. Forty-three (53%) seroconverted at one month after dose 1; of these, 26% were seroprotected (anti-HBs> 10 mIU/mL). Seroprotection at one month after doses 2 and 3 was 99% and 100%, respectively. Geometric mean titres of anti-HBs in subjects who seroconverted were 11 (range 2-366), 266 (8-7469) and 2246 (102-23680) mIU/mL, respectively. One subject developed urticarial rash after the second dose; there was no other adverse event. We conclude that this vaccine is safe and efficacious, providing significant protection even after two doses.

Hepatic fibrogenesis using chronic arsenic ingestion: studies in a murine model

Chronic oral arsenic (As) ingestion has been alleged to cause hepatic fibrosis, non-cirrhotic portal fibrosis and cirrhosis of the liver. The present study was aimed to investigate if hepatic fibrogenesis and non-cirrhotic portal fibrosis (NCPF) is caused by arsenic. A significant increase in the hepatic protein and collagen was seen compared with controls; hepatic 4-hydroxyproline levels, indicative of fibrogenesis, were increased 4-14 folds with different dosages of arsenic compared to the controls. Hepatocellular necrosis and inflammation were negligible to mild in all the groups. None of the animals developed significant splenomegaly or features of non-cirrhotic portal hypertension. The results suggest that (i) prolonged oral arsenic ingestion in mice leads to significant hepatic fibrogenesis and collagen synthesis with minimal hepato-cellular injury; (ii) arsenic ingestion alone is unlikely to cause non-cirrhotic portal fibrosis or cirrhosis of liver. This murine model of arsenic feeding could be used for the evaluation of new antifibrotic agents for the liver.

End-to-end color printer calibration by total least squares regression

Neugebauer modeling plays an important role in obtaining end-to-end device characterization profiles for halftone color printer calibration. This paper proposes total least square (TLS) regression methods to estimate the parameters of various Neugebauer models. Compared to the traditional least squares (LS) based methods, the TLS approach is physically more appropriate for the printer modeling problem because it accounts for errors in the measured reflectance of both the primaries and the modeled samples. A TLS method based on print measurements from single-colorant step-wedges is first developed. The method is then extended to incorporate multicolorant print measurements using an iterative algorithm. The LS and TLS techniques are compared through tests performed on two color printers, one employing conventional rotated halftone screens and the other using a dot-on-dot halftone screen configuration. Our experiments indicate that the TLS methods yield a consistent and significant improvement over the LS-based techniques for model parameter estimation. The gains from the TLS method are particularly significant when the number of patches for which measured data is available is limited.

CC-chemokine receptor 6 is expressed on diverse memory subsets of T cells and determines responsiveness to macrophage inflammatory protein 3 alpha

CC-chemokine receptor (CCR) 6 is the only known receptor for macrophage inflammatory protein (MIP)-3alpha, a CC chemokine chemotactic for lymphocytes and dendritic cells. Using anti-serum that we raised against the N-terminal residues of CCR6, we have characterized the surface expression of CCR6 on peripheral blood leukocytes and we have correlated CCR6 expression with responses to MIP-3alpha. We found that CCR6 was expressed only on memory T cells, including most alpha4beta7 memory cells and cutaneous lymphocyte-associated Ag-expressing cells, and on B cells. Accordingly, chemotaxis of T cells to MIP-3alpha was limited to memory cells. Moreover, calcium signals on T cells in response to MIP-3a were confined to CCR6-expressing cells, consistent with CCR6 being the only MIP-3alpha receptor on peripheral blood T cells. Unlike many CC chemokines, MIP-3alpha produced a calcium signal on freshly isolated T cells, and CCR6 expression was not increased by up to 5 days of treatment with IL-2 or by cross-linking CD3. Despite their surface expression of CCR6, freshly isolated B cells did not respond to MIP-3alpha. In addition to staining peripheral blood leukocytes, our anti-serum detected CCR6 on CD34+ bone marrow cell-derived dendritic cells. Our data are the first to analyze surface expression of CCR6, demonstrating receptor expression on differentiated, resting memory T cells, indicating differences in receptor signaling on T cells and B cells and suggesting that CCR6 and MIP-3alpha may play a role in the physiology of resting memory T cells and in the interactions of memory T cells, B cells, and dendritic cells.

Successful long-term in vitro cultivation of Theileria annulata schizonts in media supplemented with homologous and heterologous sera

The efficacy of medium RPMI-1640 supplemented with either foetal bovine, normal bovine, goat or sheep sera was compared for prolonged in vitro propagation of Theileria annulata (Hisar) schizonts. Medium RPMI-1640 supplemented with 20% foetal bovine serum (standard growth medium) resulted in optimum growth of T. annulata (Hisar) schizonts in vitro. Comparable viability and non-viability counts were observed in growth media supplemented with normal bovine or goat sera. However, viability counts in medium supplemented with sheep serum were significantly lower than that of the standard medium. Mitotic indices of cultures of T. annulata (Hisar) schizonts were directly related to the extent of cell growth and were lower in various growth media supplemented with normal bovine, goat or sheep sera than in that of the standard medium. The results suggested that normal bovine and goat sera could be successfully used in place of foetal bovine serum in the growth medium for long-term in vitro propagation of T. annulata schizonts. The study will help in reducing the cost of large-scale in vitro propagation of T. annulata aimed at mass production of the cell culture vaccine.

Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial

CONTEXT

Chronic fatigue syndrome (CFS) is associated with a dysregulated hypothalamic-pituitary adrenal axis and hypocortisolemia.

OBJECTIVE

To evaluate the efficacy and safety of low-dose oral hydrocortisone as a treatment for CFS.

DESIGN

A randomized, placebo-controlled, double-blind therapeutic trial, conducted between 1992 and 1996.

SETTING

A single-center study in a tertiary care research institution.

PATIENTS

A total of 56 women and 14 men aged 18 to 55 years who met the 1988 Centers for Disease Control and Prevention case criteria for CFS and who withheld concomitant treatment with other medications.

INTERVENTION

Oral hydrocortisone, 13 mg/m2 of body surface area every morning and 3 mg/m2 every afternoon, or placebo, for approximately 12 weeks.

MAIN OUTCOME MEASURES

A global Wellness scale and other self-rating instruments were completed repeatedly before and during treatment. Resting and cosyntropin-stimulated cortisol levels were obtained before and at the end of treatment. Patients recorded adverse effects on a checklist.

RESULTS

The number of patients showing improvement on the Wellness scale was 19 (54.3%) of 35 placebo recipients vs 20 (66.7%) of 30 hydrocortisone recipients (P =.31). Hydrocortisone recipients had a greater improvement in mean Wellness score (6.3 vs 1.7 points; P=.06), a greater percentage (53% vs 29%; P=.04) recording an improvement of 5 or more points in Wellness score, and a higher average improvement in Wellness score on more days than did placebo recipients (P<.001). Statistical evidence of improvement was not seen with other self-rating scales. Although adverse symptoms reported by patients taking hydrocortisone were mild, suppression of adrenal glucocorticoid responsiveness was documented in 12 patients who received it vs none in the placebo group (P<.001).

CONCLUSIONS

Although hydrocortisone treatment was associated with some improvement in symptoms of CFS, the degree of adrenal suppression precludes its practical use for CFS.

Optimal nonnegative color scanning filters

In this correspondence, the problem of designing color scanning filters for multi-illuminant color recording is considered. The filter transmittances are determined from a minimum-mean-squared orthogonal tristimulus error criterion that minimizes the color error in estimates obtained from noisy recorded data. Nonnegativity constraints essential for physical realizability are imposed on the filter transmittances. In order to demonstrate the significant improvements obtained, the resulting filters are compared with suboptimal filters reported in earlier literature.