Genetic syndromes mimic congenital infections

Genetic syndromes that mimic congenital infection are important to recognize because of the associated risk of recurrence. We describe two brothers born to consanguineous parents with clinical features suggestive of intrauterine infection but with negative serologic investigations. Our observations suggest that Aicardi-Goutieres syndrome (AGS) and pseudo-TORCH syndrome likely represent the same disorder.

Asymptomatic lymphangitis carcinomatosis due to squamous cell lung carcinoma

Lymphangitis carcinomatosa most commonly due to primary malignancy originating in the breast, stomach, pleura and prostate but may also originate from the lung itself. It is clinically characterised by progressing dyspnoea with or without cough even at an early stage. We report the case of a patient with squamous cell lung cancer presenting with asymptomatic lymphangitis carcinomatosa.

Co-existence of lichen planus and sarcoidosis

We present a 53-year-old patient with respiratory sarcoidosis who subsequently developed cutaneous lichen planus (LP). Biopsy of the skin lesions showed typical LP with no evidence of sarcoid granulomas. To the best of our knowledge the two conditions have not been reported in association.

New compounds from the seeds of Embelia ribes Burm

Phytochemical investigation of the seeds of Embelia ribes Burm. resulted in the isolation of three new compounds identified as 3-(4"-hydroxyoctadecanyloxy)-p-quinonyl-5-methylene-8-(10-pentanyloxy)-p-quinone (embelinol) (1), n-pentacosanyl-n-nonadeca-7'-en-9'-alpha-ol-1'-oate (embeliaribyl ester) (2) and 1,2,4,5-tetrahydroxy 3-undecanyl benzene (embeliol) (3) along with the known compound 2,5-dihydroxy-3-undecyl-2,5-cyclohexadiene-1,4-dione (embelin) (4). Their structures have been established on the basis of spectral data analyses and chemical reactions.

Socio-economic status of chronic arsenicosis patients in Bangladesh

The study showed that the maximum number of arsenicosis patients (71%) belonged to low income group and 29% belong to middle class income group but none was found in high income group and all these patients were from rural areas of the country. Majority of all these patients was related with the traditional occupation of the country like cultivation (53%) in addition to lower level of educational background (81.5%). Most of the patients of chronic arsenicosis were suffering from malnutrition (91%). The present study which reflects that the vast majority of patients of chronic arsenicosis in the country belonged to low income group, but also to low educational background and individuals, who had been suffering from malnutrition, needs a special consideration in the management of the problem. Emphasis has been given to have access to arsenic-free water and protein rich diet to people of arsenic affected areas.

Mutation and polymorphism analysis of TSC1 and TSC2 genes in Indian patients with tuberous sclerosis complex

OBJECTIVE

To find the mutation and polymorphism spectrum of TSC1 and TSC2 genes in patients affected with tuberous sclerosis complex from the Indian population.

MATERIAL AND METHODS

All coding exons and promoter regions of both TSC genes were screened for mutations and polymorphisms in 24 TSC families using polymerase chain reaction-single strand conformation polymorphism and DNA sequencing techniques.

RESULTS

A single previously known mutation, c.2111_2112delAT was identified in the TSC1 gene. A total of 11 mutations were identified in the TSC2 gene. Of these, seven mutations, c.137_138delGA, c.2070delC, c.2087_2088insAA, c.3080T>C (p.L1027P), c.648+1G>A, c.3131+1G>A and c.5034C>G were novel. The remaining four mutations, c.4544_4547delACAA, c.1941_1942insT, c.1831C>T (p.R611W) and c.1832G>A (p.R611Q) had been reported previously in other populations. The novel mutation, c.137_138delGA was predicted to result in the production of a very small tuberin protein of 64 amino acids lacking all seven functional domains. In addition, we also detected three and 10 polymorphisms in the TSC1 and TSC2 genes respectively. DNA sequence analysis of promoter regions of both TSC genes in 24 families did not show any variation.

CONCLUSIONS

This is the first molecular genetic study of TSC in an Indian population. A total of 12 mutations were detected in 24 Indian TSC families in TSC genes. All except one mutation were detected in the TSC2 gene. No variation was found in the promoter regions of either gene. As observed in the western and Japanese populations, the mutations were scattered across the TSC2 gene.

Effect of aqueous extract of Cyamopsis tetragonoloba Linn. beans on blood glucose level in normal and alloxan-induced diabetic rats

Effect of feeding orally the aqueous extract of beans of Cyamopsis tetragonoloba was investigated on fasting blood glucose levels in glucose loaded, normal and alloxan-induced diabetic rats and compared with gliclazide, a reference drug. The aqueous extract of beans at 250 mg/kg body wt significantly lowered blood glucose levels in alloxan-induced diabetic rats within 3 hr of administration. Continued administration of the extract at the same dose daily for 10 days produced statistically significant reduction in the blood glucose levels while marginal activity was seen in normal and glucose-loaded rats.

Factors influencing the results of surgery for hypospadias: experience at NICH

OBJECTIVE

To evaluate the factors that may influence the results of surgery after hypospadias repair at National Institute of Child Health, Karachi.

METHODS

It was a retrospective observational study. Files of all patients who had Hypospadias repair were retrieved and analysed with a view to identify the factors which may influence the results of surgery for Hypospadias. Patients with complete record available were included in the study, whereas those with incomplete data were excluded. For most patients who had penile or distal hypospadias TIP (Tubularised Incised Plate) urethroplasty was performed. Patients with severe chordee had Duckett Island flap urethroplasty as a two stage procedure. Patients having moderate chordee were subjected to the Mustardee Procedure. Some underwent MAGPI and Mathieu's repairs.

RESULTS

One hundred four patients were operated. Files of only 46 patients with a mean age of 4 years could be retrieved and these were included in the study. Twenty five patients had TIP urethroplasty, 5 had island flap urethroplasty, 2 had Mustardee repair, 6 had MAGPI, 5 had Mathew's repair and 3 had Byers Staged Urethroplasty. Over all incidence of fistula formation was 26%. The frequency of fistula formation was less with TIP urethroplasty (16%) compared to those who received no dartos pedicle flap. Mathieu's repair gave good results with 20% incidence of fistula formation. Highest numbers of complications (60%) were seen in patients who had Island flap urethroplasty for proximal hypospadias with chordee.

CONCLUSION

TIP urethroplasty is a safe and reliable method of hypospadias repair. The results of surgery can however be improved by using dartos pedicle flap to protect the repair, meticulous surgical techniques, use of monofilamentous absorbable suture material and soft waterproof dressing.

Homologous transplantation of the mitral valve: a review

Numerous experimental studies were conducted on homologous transplantation of the mitral valve either for mitral or tricuspid valve replacement in the early '60s. The first mitral homograft in humans was performed in 1965 by Senning. Since that time, there has been a limited number of implants mainly because of technical difficulties related to the insertion of the papillary muscles. Based on principles established for mitral valve repair, a reproducible method of homograft replacement of the mitral valve was described. Following validation in animals, the technique was applied in a series of 104 patients undergoing partial or complete mitral valve replacement. Significant improvements concerned: selection of indications and contraindications, staged approach according to the extent of the lesions leading either to partial or total replacement, systematic use of prosthetic ring annuloplasty, understanding of papillary muscle anatomy allowing a rationale for a reliable attachment method. In hospital mortality was 3.8%. At 8 years, the incidences of patients free from cardiac death and from all death were 90.6% and 82% respectively. Freedom from any cardiac event (death or reoperation) was 72% at 7 years. Similarly to the aortic homograft, mitral homograft durability was decreased in younger patients. Partial homograft replacementoffered satisfactory results particularly in the case of endocarditis and enhanced the possibilities of valve repair. The limitations of the technique are: the technical difficulty which does not permit a completely standardized operation, the risk of early valve dysfunction related to valve mismatch and the risk of late deterioration mainly leading to stenosis. Homologous transplantation of the mitral valve was also applied for tricuspid valve replacement in the case of infective endocarditis or for replacement of a degenerated bioprosthesis. Satisfactory results have been reported. However due to the lack of anatomical landmarks, the implantation procedure has remained technically challenging. Thus until further progress demonstrates a clear superiority of the mitral homograft, bioprosthesis remains the gold standard for replacing the mitral or the tricuspid valve with a biological substitute.

Diabetic nephropathy as a cause of end-stage renal disease in Egypt: a six-year study

The prevalence of diabetic nephropathy as a cause of end-stage renal disease [ESRD] in Egypt has been examined in small cross-sectional studies, with conflicting results. The need for a large-scale study prompted us to perform this 6-year multiple cross-sectional study. A sample of ESRD patients enrolled in the Egyptian renal data system was evaluated during the period 1996-2001 for the prevalence of diabetic nephropathy. Prevalence gradually increased from 8.9% in 1996, to 14.5% in 2001. The mean age of patients with diabetic nephropathy was significantly higher than that of patients with ESRD from other causes. Mortality was also significantly higher in diabetic patients with ESRD

Effect of water extract of Psidium guajava leaves on alloxan-induced diabetic rats

A water extract of Psidium guajava leaves was screened for hypoglycemic activity on alloxan-induced diabetic rats. In both acute and sub-acute tests, the water extract, at an oral dose of 250 mg/kg, showed statistically significant hypoglycemic activity.

Congenital glaucoma and brain stem atrophy as features of Aicardi-Goutières syndrome

We report on three children from two families with Aicardi-Goutières syndrome. All three had congenital glaucoma. Additionally, neuroimaging demonstrated significant brain stem atrophy in the affected sib-pair. These features have not been previously described in Aicardi-Goutières syndrome and expand the phenotypic spectrum.

Flexural Bazex syndrome associated with tonsillar adenocarcinoma

Bazex Syndrome (acrokeratosis paraneoplastica) is characterized by a psoriasiform skin eruption that favors acral sites and has been associated with underlying malignancy in all reported cases. Squamous cell carcinoma of the upper third of the respiratory system and upper third of the gastrointestinal tract and squamous cell carcinoma of unknown primary with cervical lymph node metastasis are the most commonly associated neoplasms. Here we report a case of flexural Bazex syndrome with tonsillar adenocarcinoma.

Fly ash leachate induces oxidative stress in freshwater fish Channa punctata (Bloch)

Oxidative stress inducing potential of fly ash leachate (FAL) was studied in a freshwater fish, Channa punctata (Bloch). Fish were exposed to fly ash leachate for 24 h and lipid peroxidation (LPO) was studied as a marker of oxidative stress. Catalase (CAT), glutathione S-transferase (GST) activities and levels of reduced glutathione (GSH) were also estimated in the exposed fish. FAL (1 ml/l) induced LPO in all the organs and most prominent response was in the gill. It also caused induction of enzymes and glutathione. Liver showed highest level of induction of enzyme activities. The results of this study demonstrate that fly ash constituents have potential to induce oxidative stress in fish and gills are the most vulnerable organs. It is also suggested that in case of exposure to FAL, along with LPO antioxidant defense is also activated to counteract the reactive oxygen species (ROS) at least partly in the initial stages of exposure.

A new homotriterpene from the roots of Marsdenia tenacissima Wight and Arn

A new homotriterpene isolated from the roots of Marsdenia tenacissima Wight et Arn. has been characterized as 13-(31,32-dimethyl-30-methylene-21alpha-acetoxytetradecanyl)-29-methyl-perhydrophenanthr-1,3-diene on the basis of spectral analyses.

Tissue reaction to titanium debris following Swanson arthroplasty in the hand: a report of two cases

Silicone abrasion particles are known to cause inflammatory changes following Swanson arthroplasty. Titanium grommets were introduced to protect the implants from wear and abrasion. Two cases with histological evidence of symptomatic titanium particulate tissue inflammation following Swanson joint replacement with grommets are presented.

Pupil-led sex education in England (RIPPLE study): cluster-randomised intervention trial

BACKGROUND

Improvement of sex education in schools is a key part of the UK government's strategy to reduce teenage pregnancy in England. We examined the effectiveness of one form of peer-led sex education in a school-based randomised trial of over 8000 pupils.

METHODS

29 schools were randomised to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). In intervention schools, peer educators aged 16-17 years delivered three sessions of sex education to 13-14 year-old pupils from the same schools. Primary outcome was unprotected (without condom) first heterosexual intercourse by age 16 years. Analysis was by intention to treat.

FINDINGS

By age 16 years, significantly fewer girls reported intercourse in the peer-led arm than in the control arm, but proportions were similar for boys. The proportions of pupils reporting unprotected first sex did not differ for girls (8.4% intervention vs 8.3% control) or for boys (6.2% vs 4.7%). Stratified estimates of the difference between arms were -0.4% (95% CI -3.7% to 2.8%, p=0.79) for girls and -1.4% (-4.4% to 1.6%, p=0.36) for boys. At follow-up (mean age 16.0 years [SD 0.32]), girls in the intervention arm reported fewer unintended pregnancies, although the difference was borderline (2.3% vs 3.3%, p=0.07). Girls and boys were more satisfied with peer-led than teacher-led sex education, but 57% of girls and 32% of boys wanted sex education in single-sex groups.

INTERPRETATION

Peer-led sex education was effective in some ways, but broader strategies are needed to improve young people's sexual health. The role of single-sex sessions should be investigated further.

A novel antifungal pyrrole derivative from Datura metel leaves

Phytochemical investigation of the leaves of Datura metel Linn. led to the isolation of a new pyrrole derivative 1 which was characterised as 2beta-(3,4-dimethyl-2,5-dihydro-1H-pyrrol-2-yl)-1'-methylethyl pentanoate on the basis of spectral data analyses and chemical reactions. Compound 1 was endowed with antifungal activity and its MIC was found to be 87.5 microg/ml. Two proteins having molecular weights of 42 and 58 kD of Aspergillus fumigatus are potential targets for compound 1.

Diabetic nephropathy as a cause of end-stage renal disease in Egypt: a six-year study

The prevalence of diabetic nephropathy as a cause of end-stage renal disease (ESRD) in Egypt has been examined in small cross-sectional studies, with conflicting results. The need for a large-scale study prompted us to perform this 6-year multiple cross-sectional study. A sample of ESRD patients enrolled in the Egyptian renal data system was evaluated during the period 1996-2001 for the prevalence of diabetic nephropathy. Prevalence gradually increased from 8.9% in 1996, to 14.5% in 2001. The mean age of patients with diabetic nephropathy was significantly higher than that of patients with ESRD from other causes. Mortality was also significantly higher in diabetic patients with ESRD.

Comparison of the OptiMAL rapid antigen test with field microscopy for the detection of Plasmodium vivax and P. falciparum: considerations for the application of the rapid test in Afghanistan

To establish the sensitivity and specificity of a batch of 'OptiMAL 48' rapid antigen tests procured by the World Health Organization in Afghanistan, a sample was tested, in parallel with routine, microscopical diagnosis, at basic health units (BHU) within Afghan refugee camps in Pakistan. The results of both methods of field diagnosis were compared with those of cross-checking microscopy at a reference laboratory, which were taken as the 'gold standard'. Out of 499 patients examined, 36% were diagnosed as malaria cases by field microscopy and 34% by the rapid test. For the OptiMAL 48 test, cross-checking of the corresponding smears at the reference laboratory gave a sensitivity of 79.3% and a specificity of 99.7% for Plasmodium falciparum and corresponding values of 86.1% and 98.7% for P. vivax infections. The performance of the field microscopy was better, with a sensitivity and specificity of 85.2% and 99.7% for P. falciparum, and 90.4% and 98.7% for P. vivax, respectively. These results show that the performance of OptiMAL 48 is adequate for acute- and post-emergency situations when the alternative is just clinical diagnosis. However, in the developing health system of Afghanistan, the main focus should be on the expansion of the existing network for microscopical diagnosis and quality control, to meet the needs of a stable situation. Rapid antigen tests are more suited to investigations of outbreaks in remote situations, where health services are deficient or absent.

Antifungal potential of Indian medicinal plants

Fourteen Indian plants, selected based on their use in respiratory and other disorders in traditional systems of medicine, were analyzed for their potential activity against fungi. The antifungal activity was investigated by disc diffusion, microbroth dilution and percent spore germination inhibition tests against pathogenic Aspergilli. Methanolic extracts of Solanum xanthocarpum and Datura metel inhibited the growth of Aspergillus fumigatus, A. flavus and A. niger and their in vitro MICs were found to be 1.25-2.50 mg/ml by both microbroth dilution and percent spore germination assays. In disc diffusion assay, a concentration of 0.062 mg/disc of methanol extract of D. metel showed significant activity against Aspergilli. S. xanthocarpum exhibited similar activity at 0.125 mg/disc.