Role of azathioprine in severe ulcerative colitis: one-year, placebo-controlled, randomized trial

OBJECTIVE

To investigate the efficacy of azathioprine in treating patients with severe ulcerative colitis.

DESIGN

One-year, randomized, placebo-controlled trial.

SUBJECTS

83 patients with severe ulcerative colitis were enrolled. Fifty patients who relapsed within two months on corticosteroid withdrawal were randomized into two groups. The azathioprine group received oral sulfasalazine (6-8 g/day), oral prednisolone (1 mg/Kg/day) and oral azathioprine (2 mg/Kg/day). The placebo group received oral sulfasalazine (6-8 g/day), oral prednisolone (1 mg/Kg/day) and placebo. Corticosteroids were tapered over 12-16 weeks.

RESULTS

Five patients (2 in azathioprine group, 3 in placebo group) dropped out of the study. Three patients in the azathioprine group had side effects. The number of patients going into complete remission and partial remission was not significantly different in the two groups. The proportion of relapses in the azathioprine group was lower than in the placebo group (p < 0.05).

CONCLUSIONS

In patients with ulcerative colitis, azathioprine had no effect in achieving remission, when given in combination with prednisolone; however, it lowers the proportion of relapses. Side effects like pancreatitis and hepatitis are mild and respond promptly to drug withdrawal.

Non-traumatic rhabdomyolysis with acute renal failure

A clinical profile of non-traumatic rhabdomyolysis with acute renal failure is presented. Myoglobinuric renal failure is treatable and hence a high index of suspicion is warranted in the etiologies discussed.

Naturally occurring anti-alpha-galactosyl antibodies: relationship to xenoreactive anti-alpha-galactosyl antibodies

Antibodies produced by an individual without a known history of sensitization to the relevant antigen are called "natural" antibodies. Some natural antibodies, called xenoreactive antibodies, react with the cells of foreign species. Most xenoreactive antibodies in humans and higher primates bind to a nonreducing terminal galactose expressed by pigs and other lower mammals. Although human natural antibodies which bind to one or more of a variety of terminal alpha-galactosyl structures have been identified previously, the antigen recognized by anti-alpha-galactosyl antibodies on the cells of foreign species is thought to be exclusively Galalpha1-3Gal. Thus, anti-alpha-galactosyl antibodies which do not react with Galalpha1-3Gal are thought to be nonxenoreactive. Here, we identify natural antibodies in human serum which bind to Galalpha1-6Hexosepyrranosides but not Galalpha1-3Gal, indicating that these antibodies are not xenoreactive. Various lower mammals were found to have natural anti-Galalpha1-2Gal antibodies in their sera, suggesting that at least some anti-Galalpha1-2Gal antibodies might not be xenoreactive and indicating, surprisingly, that anti-alpha-galactosyl antibodies are much more phylogenetically disperse than previously known. Also surprising was the finding that some natural antibodies which bind to Galalpha1-3Gal in vitro do not bind to porcine xenografts. These studies show that naturally occurring anti-alpha-galactosyl antibodies in mammalian serum include antibodies with a greater variety of reactivities than previously thought, only some of which would bind to a porcine xenograft. Further, these studies show that the methods used to detect anti-alpha-galactosyl antibodies of relevance in xenotransplantation must be carefully evaluated to avoid detection of anti-alpha-galactosyl antibodies which would not bind to a porcine organ and which therefore are not involved in xenograft rejection.

Hepatitis A and acute pancreatitis

Acute pancreatitis in association with acute viral hepatitis A in uncommon. We present the case of a young girl with acute pancreatitis complicating acute viral hepatitis A. The finding of IgM anti-HAV and exclusion of a vast array of other etiologies implicates hepatitis A the cause.

Hereditary pancreatitis

Hereditary pancreatitis is a rare cause of chronic pancreatitis and has been mainly reported in western literature. It is inherited in an autosomal dominant manner. In this report, we present our data on two affected members in a family from Punjab, North India.

Associations of MHC class II alleles with insulin-dependent diabetes mellitus (IDDM) in patients from North India

Thirty-four insulin-dependent diabetes mellitus (IDDM) patients from North India were studied with respect to their HLA class II alleles including those of the DRB1, DQA1, DQB1 and DPB1 loci, using the polymerase chain reaction (PCR) and hybridization with sequence-specific oligonucleotide probes (SSOP). They were compared with the class II alleles of 94 normal adult controls from the same ethnic background. The results show a statistically significant increase of DRB1*03011 (p < 0.00001), DQB1*0201 (p < 0.007), DQA1*0501 (0.0027) and DPB1*2601 (p < 0.0042) in patients compared to controls. DR*04 was not significantly increased. However, homozygosity for DRB1*03011 was increased more than expected. DRB1*1501 and *1502 did not show a significant decrease in the patients. However, DRB1*0701 was decreased significantly, but this difference did not remain significant when the p value was corrected for the number of alleles tested. Similarly, DPB1*2601 was increased significantly in the patients but did not remain significant after p was corrected for the number of alleles tested. However, DPB1*2601 was increased, and remained significant after correction, in patients not having HLA-DR3. We also studied the possible role of aspartic acid at codon 57 of the DQ beta chain in protection against development of diabetes, and arginine at codon 52 of the DQ alpha chain in susceptibility. We observed an increase in non-Asp57 alleles in DQ beta and Arg52 in DQ alpha in the patients, however, this effect seems to be due to the fact that the most prevalent haplotype in diabetic patients: DRB1*03011-DQA1*0501-DQB1*0201, has DQB1 and DQA1 alleles which carry non-Asp57 and Arg52, respectively.

Lepromatous leprosy presenting as a swelling in the neck

A 25-year-old electrician presented with gradually, asymptomatic swelling on left of the neck since 2 years. The swelling which was initially diagnosed as cervical lymphadenitis by the internist represented the enlarged left great auricular nerve. Cutaneous examination revealed an ill-defined, hypoaesthetic macule with minimal atrophy on the pinna of the left ear. The histopathology of the nerve showed a lepromatous neuritis with bacteriological index (BI) of 5+.

High seroprevalence of hepatitis C virus and dual infection (hepatitis B and C virus) in non-alcoholic chronic liver disease in north India

BACKGROUND

There are conflicting reports on the prevalence of hepatitis B and C virus (HBV and HCV) mediated chronic liver disease (CLD) in India.

AIM

To study the prevalence of HBV and HCV associated in CLD in north India.

MATERIAL AND METHODS

Eighty five patients (66 males, 19 females; age range 16-70 years) with unequivocal CLD were analysed. CLD patients with nonviral aetiologies were excluded. All sera were tested for anti-HCV by EIA (third generation), HBsAg, IgM and IgG anti-HBc, HBeAg/Anti-HBe by EIA (Abbott Diagnostics, IL). Positive anti-HCV results were confirmed by RIBA-II assay.

RESULTS

Sixteen (18.8%), 22 (25.9%) and 21 (24.7%) patients had HBV, HCV and HBV + HCV infection, respectively. Twenty six (30.6%) CLD patients had no viral markers.

CONCLUSION

HCV is emerging as an important cause of CLD in India. Dual infection (HBV + HCV) is seen in 25% patients. Dual infection influences the prognosis and response rates to interferon therapy.

Optic nerve cysticercosis in the optic canal

The authors present a first case of cysticercosis in the optic canal in a fifteen-year-old female patient. Cysticercosis of the optic nerve is rare. A cyst in the optic canal, beneath the sheath of the optic nerve, has never been reported. The patient presented with rapidly diminishing vision in the left eye, headache and papillitis. A magnetic resonance imaging revealed a cystic lesion at the entrance of the optic canal. Surgery performed was a transcranial orbitotomy which included deroofing of the optic canal and removal of the cyst from under the sheath of the optic nerve. The cyst proved to be cysticercus histopathologically. The outcome was a remarkable visual recovery.

Determination of rifampicin and its main metabolite in plasma and urine in presence of pyrazinamide and isoniazid by HPLC method

A reversed phase HPLC method is described for the simultaneous estimation of rifampicin and its major metabolite desacetyl rifampicin, in the presence of isoniazid and pyrazinamide, in human plasma and urine. The assay involves simple liquid extraction of drug, metabolite and internal standard (rifapentine) from biological specimens and their subsequent separation on a C18 reversed phase column and single wavelength UV detection. In plasma as well as in urine samples, all the three compounds of interest eluted within 17 min. Using methanol-sodium phosphate buffer (pH 5.2; 0.01 M) (65:35, v/v) as mobile phase under isocratic conditions, it was established that isoniazid, pyrazinamide and ascorbic acid (added to prevent oxidative degradation of analytes) did not interfere with the analyte peaks. Recoveries (extraction efficiency) for drug were greater than 90% in both plasma and urine, whereas for metabolite the values were found to be 79 and 86% in plasma and urine, respectively. The plasma and urine methods were precise (total coefficient of variation ranged from 5 to 23%) and accurate (-7 to 5% of the nominal values) for both the analytes. Individual variance components, their estimates and their contribution to the total variance were also determined. Using the same method, unknown samples supplied by WHO were assayed and good correlations were obtained between the found and intended values. The method developed proved to be suitable for simultaneous estimation of rifampicin and desacetyl rifampicin in plasma and urine samples.

Chemo-inflammation-an effective treatment for freckles

Freckles are fairly common and considered to be incurable. We have developed a new technique called "Chemo-inflammation" with which we have treated 5 patients (4 girls and one boy) having extensive freckles with excellent results. All the freckles disappeared completely from the treated areas and there has been no recurrence so far. The technique consists of applying a liquid based on an alkyl sulphate, on the affected skin and repeating the application every hour for a day till the entire skin develops adequate inflammation. The liquid is then washed off with tap water and the skin is treated with topical (or systemic) corticosteroids till the inflammation subsides and the treated skin peels off and attains its normal texture. This generally happens within a week or so. Post-inflammatory hyperpigmemation has to be prevented by adequate anti-inflammatory treatment. Otherwise there are no precautions.

Synthetic peptides: a modern approach to vaccination

For induction of humoral or cell-mediated immunity, development of synthetic peptide vaccines present a novel approach and a better alternative to conventional vaccines. Construction of synthetic peptides that mimic antigenic sites is the basis of this approach. In this article various methodologies involved in the peptide synthesis are discussed. This is followed by a discussion on the strategies involved in rendering poor or non-immunogenic peptides immunogenic. These include coupling to large carrier proteins, polymeric presentation and incorporation of an identified Th cell epitope into the peptide.

Use of growth hormone in non-growth hormone deficient children

The easy availability of growth hormone (GH) in the Indian market has led to its increased use in the management of short stature. However, the therapy is expensive for most families. The possible benefits of such a therapy have to be carefully weighed against the cost and adverse effects. We discuss the drawbacks of relying on data based on predicted height to evaluate the benefits of GH therapy reported in the literature. It is the final adult height which is the true indicator of the efficacy of GH therapy. The only clear indications for GH therapy are short stature associated with GH deficiency and Turner syndrome. Classifying short stature may not be of much help in deciding the utility of GH therapy and the use of auxological criteria alone will increase the burden on society. At present, the use of GH in idiopathic short stature is not indicated in routine clinical practice.

Substituted carboranes and polyhedral hydroborate salts as anti-neoplastics

Substituted carboranes and polyhedral hydroborate salts were observed to be potent anti-neoplastic/cytotoxic agents inhibiting the growth of mouse and human leukemias, human uterine, colon adenocarcinoma, lung bronchogenic and gliomas. Amino-o-carborane-hydrochloride 7, one of the more potent compounds, preferentially inhibited Tmolt3 DNA synthesis. The target of the agent appears to be de novo purine synthesis with significant inhibition of the activities of both regulatory enzymes, PRPP-amido transferase and inosine monophosphate dehydrogenase as well as dihydrofolate reductase. The agent also inhibited nucleoside kinase activities leading to reductions in deoxyribonucleotide pools. The DNA molecule itself was not a target of the agent.