Vascularised joint transfer in the management of recurrent giant cell tumour of the second metacarpal

This paper presents the medium-term follow-up results (34 and 40 months, respectively) of two cases of recurrent giant cell tumour of the head of the second metacarpal, treated by marginal excision and reconstruction with a vascularised toe joint transfer. Both patients had painless, stable joints with excellent ranges of motion at the metacarpophalangeal joint of 80 degrees and 70 degrees , respectively, no degenerative changes and no recurrence of the tumours.

Purpura fulminans in a complicated Falciparum malaria

A 19-year-old male presented with fever, oliguria and purpuric lesions involving both hands. The patient was diagnosed as a case of purpura fulminans with disseminated intravascular coagulation due to complicated Falciparum malaria. The case is presented to sensitize the physicians to keep malaria as a differential in cases of fever with purpura fulminans.

Autoimmune hemolytic anemia

OBJECTIVE

To study the clinico-hematological profile and treatment outcome in children suffering from auto immune hemolytic anemia (AIHA).

METHODS

Twelve children were diagnosed with auto immune hemolytic anemia over a period of four years. Direct antiglobulin test was positive in all the cases. Other causes of hemolytic anemia like thalassemia syndromes, hereditary spherocytosis, G6PD deficiency were excluded by appropriate tests. The children were followed up for 6 months to 4 years.

RESULTS

The age ranged from 7 mth to 9 yr with a mean age of 4.51 yr. All patients had pallor as the presenting complaint followed by splenomegaly (83.3%), jaundice (66.7%), fever (50%) and bleeding manifestations (16.7%). 9 patients had primary disease and 3 had secondary disease. Tubercular infection was seen in 2 patients with secondary disease. Jaundice was seen equally in both the groups. Oral prednisolone produced remission in 83.3% cases. 4 patients (3 in primary and one in secondary group) had relapse after initial response. All responded to a second course of steroids but had subsequent relapses and developed a chronic course.

CONCLUSION

Autoimmune hemolytic anemia is an uncommon cause of hemolytic anemia in children. Tubercular infection is an underlying pathology in cases of secondary autoimmune hemolytic anemia. Although oral steroids induce remission in most of the cases, relapses are common.

Factors influencing varicella zoster virus infection after allogeneic peripheral blood stem cell transplantation: low-dose acyclovir prophylaxis and pre-transplant diagnosis of lymphoproliferative disorders

Varicella zoster virus (VZV) infection is one of the frequent opportunistic infections after allogeneic bone marrow transplantation, with a high incidence of 30-50%. However, no data have been reported on VZV infection after allogeneic peripheral blood stem cell transplantation (PBSCT).

PATIENTS AND METHODS

We report a retrospective analysis of VZV infection in 192 allogeneic PBSCT recipients. Twenty-seven patients (14%) received long-term prophylaxis of low-dose acyclovir (200 mg twice daily orally > or =3 months) for recurrent oral (n=21) or genital herpes simplex virus infection (n=5) or for a previous history of recurrent VZV infection (n=1).

RESULTS

Forty-two patients (22%) developed VZV infections: localized (n=37) and disseminated infection (n=5). The incidence of VZV infection at 1 and 3 years was 19.3+/-3.3% and 36.8+/-5.2%, respectively. Complications included post-herpetic neuralgia (n=18, 43%), secondary bacterial infections (n=3), and intracranial hemorrhage (n=1) with 2 deaths. A higher risk factor for VZV infection was pre-transplant diagnosis of a lymphoproliferative disorder (LPD): chronic lymphocytic leukemia, Hodgkin's disease, or non-Hodgkin's lymphoma (P=0.021, 52.5% in LPD vs. 32.6% in non-LPD group). The use of low-dose acyclovir prophylaxis (P=0.043, 14.7% in acyclovir vs. 41.6% in nonacyclovir group) was found to be protective. Although no VZV infection episodes were noted during the period of acyclovir prophylaxis, 3 episodes of VZV infection were noted after acyclovir cessation.

CONCLUSION

The incidence of VZV infection after PBSCT was high at 36.8%, with patients transplanted for LPDs at higher risk. The long-term use of low-dose acyclovir may be protective for VZV infection, although it does not completely prevent rebound of late VZV infection.

Correlation between clinical features and degree of immunosuppression in HIV infected children

We conducted this study to find out correlation of CD4% with clinical status in 102 HIV infected antiretroviral naive children. Mean age of presentation was 4.8 years. Perinatal transmission was the commonest mode of transmission (94%). Fever (53%), chronic diarrhea (36%), and cough (29%) were the commonest presenting symptoms. Protein energy malnutrition was seen in 56.7% of children. 33.3% children were asymptomatic, whereas 45.1% were in WHO clinical stages III and IV at the time of presentation. The most common opportunistic infection was tuberculosis. CD4% correlated significantly with the deterioration of the WHO clinical stages (P<0.01) and increasing grades of protein energy malnutrition (P< 0.05).

A study of bone marrow failure syndrome in children

BACKGROUND

Bone marrow failure syndrome (BMFS), or aplastic anemia, includes peripheral blood single cytopenias, as well as pancytopenia due to inability of the marrow to effectively produce blood cells.

AIM

To study the clinico-hematological profile and etiological factors of bone marrow failure syndrome in children.

SETTING AND DESIGN

This prospective study was carried out in the Department of Pediatrics of a university teaching hospital over 36 months.

MATERIALS AND METHODS

Children with pancytopenia (Hb 9 /L, platelet count<100x10(9)/L) and bone marrow cellularity<25% were included in the study. History of exposure to drugs, socioeconomic status, ethnicity and occupation of father were noted. Bone marrow aspiration; trephine biopsy; Ham test; viral studies for hepatitis A, B and C; and cytogenetic investigations were carried out.

STATISTICAL ANALYSIS

Relative risk was estimated by odds ratio (OR) with 95% confidence interval (CI) in matched cases and controls.

RESULTS

Of the 53 children studied, 6 (11.3%) were diagnosed as Fanconi anemia. Two cases had features of myelodysplastic syndrome. Forty-five children were labeled as acquired aplastic anemia, of whom one had evidence of hepatitis B infection and two patients (5.8%) had paroxysmal nocturnal hemoglobinuria. Aplastic anemia was more common in children from family with lower socioeconomic status; in Muslims; and where the father's occupation was weaving, dyeing and painting. However, the number was small to make statistically significant conclusions. No correlation could be established with exposure to drugs.

CONCLUSION

Fanconi anemia was responsible for approximately one-tenth of the cases of bone marrow failure syndrome. Majority of the patients had acquired aplastic anemia. Hepatitis B infection was an uncommon cause of acquired aplastic anemia.

QTL analysis reveals context-dependent loci for seed glucosinolate trait in the oilseed Brassica juncea: importance of recurrent selection backcross scheme for the identification of 'true' QTL

Seed glucosinolate content in Brassica juncea is a complex quantitative trait. A recurrent selection backcross (RSB) method with a doubled haploid (DH) generation interspersing backcross generations was used for the introgression of low glucosinolate alleles from an east European gene pool B. juncea line, Heera into an Indian gene pool variety, Varuna. Phenotypic comparisons among the DH populations derived from early to advanced backcrosses revealed a shift in the mean values for various glucosinolates with the advancement of backcrossing, indicating a change in the selective values of the alleles with change in the genetic background due to the existence of epistasis and context dependencies. QTL mapping for various seed glucosinolates from early (F(1)DH) and advanced generation (BC(4)DH) populations confirmed the presence of epistasis and context dependency. The common QTL detected in both F(1)DH and BC(4)DH changed their R (2) values from the former to the later generation. Some of the QTL detected in the F(1)DH became irrelevant in the BC(4)DH population. Further, new QTL were detected in the BC(4)DH population for various glucosinolates. A validation study on a population of low glucosinolate DH lines derived from all the backcross generations of the RSB breeding programme revealed that the QTL detected in BC(4)DH were the 'true' QTL. Using glucosinolate as an example, the study provides strong evidence for the importance of the RSB method for the identification of the 'true' QTL which would be significant for marker assisted introgression of a complex quantitative trait whose expression is influenced by epistatic interactions.

Why are we waiting? A study of the patients' perspectives about their protracted stays in an emergency department

The overcrowding of Emergency Departments compromises their critical function and the safety of patients and staff. This study asked the patients how the wait in overcrowded conditions impacted on them and the care they received and what they believed the reasons for the overcrowding were. A prospective questionnaire based structured interview study was performed. Over half (57.7%) of patients felt that the lack of inpatient beds and wards was the main reason that they experienced delays. An overwhelming 85.9% felt that the Health Authorities were not doing enough to address the overcrowding issue. Overcrowding of Emergency Departments has been identified as a major problem the solution is to be found in increasing the capacity of the acute hospital system according to the majority of our study population.

Promoters of two anther-specific genes confer organ-specific gene expression in a stage-specific manner in transgenic systems

Differential screening of a stage-specific cDNA library of Indica rice has been used to identify two genes expressed in pre-pollination stage panicles, namely OSIPA and OSIPK coding for proteins similar to expansins/pollen allergens and calcium-dependent protein kinases (CDPK), respectively. Northern analysis and in situ hybridizations indicate that OSIPA expresses exclusively in pollen while OSIPK expresses in pollen as well as anther wall. Promoters of these two anther-specific genes show the presence of various cis-acting elements (GTGA and AGAAA) known to confer anther/pollen-specific gene expression. Organ/tissue-specific activity and strength of their regulatory regions have been determined in transgenic systems, i.e., tobacco and Arabidopsis. A unique temporal activity of these two promoters was observed during various developmental stages of anther/pollen. Promoter of OSIPA is active during the late stages of pollen development and remains active till the anthesis, whereas, OSIPK promoter is active to a low level in developing anther till the pollen matures. OSIPK promoter activity diminishes before anthesis. Both promoters show a potential to target expression of the gene of interest in developmental stage-specific manner and can help engineer pollen-specific traits like male-sterility in plants.

Physiopathologic atlas of thyroid scintigraphy

Nuclear medicine is an excellent example of functional imaging. It has an established role in the evaluation and management of thyroid disorders. The physiologic and pathologic basis of radiotracer based thyroid imaging has been presented in this article. The same principles apply to the treatment of thyroid disorders using radioactive iodine.

Mapping of yield influencing QTL in Brassica juncea: implications for breeding of a major oilseed crop of dryland areas

Quantitative trait loci (QTL) analysis of yield influencing traits was carried out in Brassica juncea (AABB) using a doubled haploid (DH) mapping population of 123 lines derived from a cross between Varuna (a line representing the Indian gene pool) and Heera (representing the east European gene pool) to identify potentially useful alleles from both the parents. The existing AFLP based map of B. juncea was further saturated with RFLP and SSR markers which led to the identification of the linkage groups belonging to the A (B. rapa) and B (B. nigra) genome components of B. juncea. For QTL dissection, the DH lines were evaluated at three different environments and phenotyped for 12 quantitative traits. A total of 65 QTL spread over 13 linkage groups (LG) were identified from the three environments. QTL analysis showed that the A genome has contributed more than the B genome to productivity (68% of the total QTL detected) suggesting a more prominent role of the A genome towards domestication of this crop. The east European line, Heera, carried favorable alleles for 42% of the detected QTL and the remaining 58% were in the Indian gene pool line, Varuna. We observed clustering of major QTL in a few linkage groups, particularly in J7 and J10 of the A genome, with QTL of different traits having agronomically antagonistic allelic effects co-mapping to the same genetic interval. QTL analysis also identified some well-separated QTL which could be readily transferred between the two pools. Based on the QTL analysis, we propose that improvement in yield could be achieved more readily by heterosis breeding rather than by pure line breeding.

First Report of Sclerotial Rot of Saffron Caused by Sclerotium rolfsii in India

Saffron (Crocus sativus L.) is highly desirable as a condiment and is also used for medicinal purposes. In India, saffron is cultivated in 2,825 ha with a production of 6,048 t and an average yield of 2.28 kg/ha. Approximately 70 to 80% of the saffron crop in 25 commercial fields in the Kishtwar District of Jammu and Kashmir, India was affected with a corm rot from October 2005 to 2006. In newly infested fields, the disease occurred in small patches that gradually enlarged each year. Symptoms appeared as brown-to-dark brown sunken, irregular patches below corm scales. Lesions were usually 1 mm deep with raised margins. Severely infected corms had foliage that dried from the tip downward. White fungal mycelia appeared on the bulbs that rotted at later stages of disease development. Sclerotia formation was observed. For isolation of the pathogen, small bits of the infected tissue were surface sterilized in 0.1% mercuric chloride and washed three times in sterile distilled water. The surface-sterilized pieces were placed aseptically on potato dextrose agar and incubated at 28 ± 1°C for 3 days. The fungus was characterized by hard, brown-to-black sclerotia that was 1 to 2.1 mm in diameter with a pseudoparenchymatous rind. These were produced on sterile, cottony white mycelium with clamp connections. On the basis of morphological characteristics (3), the fungus was identified and deposited as Sclerotium rolfsii Sacc. at the Indian Type Culture Collection Center, IARI-New Delhi as ID No. 6491.07. Pathogenicity tests were carried out in a growth chamber maintained at 28 ± 1°C. S. rolfsii was grown in potato dextrose broth for 7 days and then blended to make a mycelial suspension. Fifty milliliters (1 × 10⁴ hyphal fragments per ml) of the suspension was mixed in each kilogram of sterilized soil and placed in pots. Healthy saffron corms were planted in 10 pots containing soil infested with S. rolfsii, and five pots with noninfested soil served as controls. Symptoms appeared on eight corms 9 to 10 days after planting. Signs of the pathogen in the form of mycelia and sclerotia were also present. The corms rotted and died 12 to 14 days after inoculation. Control plants did not display any symptoms. S. rolfsii was reisolated from infected bulbs, thus proving Koch's postulates. Corm rot caused by Fusarium spp., Penicillium spp., and Rhizoctonia spp. is also reported on saffron (2). Fusarium oxysporum f. sp. gladioli has been reported in Italy (1). To our knowledge, this is the first report of S. rolfsii as being pathogenic on saffron from India. References: (1) P. Di Primo and C. Cappelli. Plant Dis. 84:806, 2000. (2) M. G. Hassan and L. Sobita Devi. Indian Phytopathol. 56:122, 2003. (3) Z. K. Punja and A. Damiani. Mycologia 88:694, 1996.