Extensively drug-resistant tuberculosis: experience at the Tuberculosis Research Centre, Chennai, India

Ten extensively drug-resistant tuberculosis (XDR-TB) patients were identified among 104 human immunodeficiency virus negative multidrug-resistant tuberculosis (MDR-TB) patients treated at the Tuberculosis Research Centre, Chennai, India, in two different cohorts between 1999-2003 and 2006-2007. They were managed with individualised treatment regimens. At the time of diagnosis of MDR-TB, one patient had XDR-TB and three had initial ofloxacin resistance. One patient who had had a lobectomy in addition to chemotherapy became bacteriologically negative, three died, three defaulted and the remaining three, who are bacteriologically positive, are still continuing treatment. Although based on a small number of patients, our results have not been encouraging.

Dietary behaviors associated with fruit and vegetable consumption, Marion County, Indiana, 2005

INTRODUCTION

Eating inadequate amounts of fruits and vegetables is associated with diminished health, and most Americans fall short of the Centers for Disease Control and Prevention's recommendation to eat at least 2 servings of fruit and 3 servings of vegetables each day. This study assessed behaviors associated with fruit and vegetable consumption in adults.

METHODS

A cross-sectional, random-digit-dialed telephone survey of 4,784 adults living in Marion County (Indianapolis), Indiana, measured demographic characteristics, personal health data, food consumption, food label use, and other eating habits. Multivariate logistic regressions were used to assess the association between selected dietary behaviors and fruit and vegetable consumption, controlling for demographic characteristics.

RESULTS

Behaviors associated with adequate versus inadequate consumption of fruits and vegetables were frequent snacking on healthy foods (odds ratio [OR], 2.54), eating meals at home (OR, 2.09), using nutrition labels when making purchases (OR, 1.52), and using "heart healthy" symbols and other food information labels when ordering from restaurants (OR, 1.41). Frequent red meat consumption was negatively associated with adequate consumption of fruits and vegetables (OR, 0.64).

CONCLUSION

Healthful snacking, food label use, and eating meals prepared at home may improve dietary quality. Our measure of adequacy may also be useful in future studies assessing dietary behavior and diet composition.

Abstract 3238: Synthesis and evaluation of 17-oximino-estrone derivatives as potential anti-breast cancer agents

The selective estrogen receptor modulator (SERM) tamoxifen (TAM) is the gold standard used in the treatment of estrogen-dependent breast cancer. Although it significantly benefited women with breast cancer, time-dependent tumor resistance and the risk of endometrium cancer are associated with it. Consequently, there is an urgent need for alternative treatments. PURPOSE: Incorporating the oxime moiety in conjunction with various basic side chains associated with the pharmacophore of the SERMs into estrone may yield various estrone derivatives with antiestrogenic activity. The estrone derivatives were compared to 4-hydroxy-tamoxifen (4-OH-TAM) and raloxifene (RAL). METHODS: The estrone derivatives were synthesized using established chemical procedures. The Southern Research Institute in Birmingham, Alabama carried out the cytotoxicity studies in MCF-7, MDA-MB-231 and Ishikawa cancer cells. They tested different concentrations of the six different estrone derivatives ranging from .01 nM to 100,000 nM on 5000 MCF-7 cells/well, on 5000 MDA-MB-231 cells/well and on 5000 Ishikawa cells/well. Cells pre-treated with the various estrone derivatives were incubated at 37°C for 3 days followed by MTS assay. Their IC50 values were generated using GraphPad Prism 5.0. RESULTS: Our compounds demonstrated anti-proliferative activity in MCF-7 cells but they were not as potent as 4-OH-TAM(2µM) or RAL (3µM). Compounds 2, 3, 4, 6, and 7 (31µM, 29µM, 30µM, 30µM, and 29µM respectively) were comparable in potency to RAL (28µM) in MDA-MB-231 cells but all were not as potent as 4-OH-TAM (22µM). Compounds 3, 6, and 7 (20µM, 20µM, and 17µM respectively) were comparable or greater in potency to 4-OH-TAM (20µM) in Ishikawa cells and compounds 2, 3, 6, and 7 (24µM, 20µM, 20µM, and 17µM respectively) were comparable or greater in potency to RAL (23µM). CONCLUSION: Applying the oxime moiety in conjunction with the pharmacophore of the SERMs to estrone produced agents with antiproliferative activity. They also showed antiproliferative activity in estrogen-receptor negative MDA-MB-231 cells. These results suggest that several of the estrone derivatives show promise as potential anti-breast cancer agents.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3238. doi:10.1158/1538-7445.AM2011-3238

Control of presacral venous bleeding with helical tacks on PTFE pledgets combined with pelvic packing

Persistent and torrential bleeding from presacral veins is an uncommon complication during rectal resection. Control of bleeding is often difficult. We report an effective technique for controlling sacral bleeding using endoscopic helical tackers applied over pledgets of expanded polytetrafluoroethylene.

Jejunal access loop cholangiogram and intervention using image guided access

Jejunal access loop is fashioned in patients who undergo Roux en Y hepaticojejunostomy and biliary intervention is anticipated on follow up. Post-operative study of the biliary tree through the access loop is usually done under fluoroscopic guidance. We present a series of 20 access loop cholangiograms performed in our institution between August 2004 and November 2008. We aimed to evaluate the safety and efficacy of the procedure and to highlight the role of CT guidance in procuring access. Access loop was accessed using CT (n = 13), ultrasound (n = 3) or fluoroscopic guidance (n = 4). Fluoroscopy was used for performing cholangiograms and interventions. Twelve studies had balloon plasty of the stricture at anastomotic site or high up in the hepatic ducts. Seven studies showed normal cholangiogram. Plasty was unsuccessful in one study. Technical success in accessing the jejunal access loop was 100%; in cannulation of anastomotic site and balloon plasty it was 95%. One case required two attempts. Procedure-related complications were not seen. All patients who underwent balloon plasty of the stricture were doing well for variable lengths of time. Access loop cholangiogram and interventions are safe and effective. CT guidance in locating/procuring the access loop is a good technique.

Characterization of bison (Bison bison) myoglobin

Bison is an alternate meat species gaining increased popularity in North America. Although previous investigations reported that bison meat discolors faster than beef, the molecular basis of this observation has not been investigated. Therefore, the objective of the present study was to determine the redox stability, thermostability, and primary structure of bison myoglobin (Mb), in comparison with beef Mb. Purified bison and beef myoglobins were analyzed for autoxidation, lipid oxidation-induced oxidation, and thermostability. Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry was utilized for determining the exact molecular mass of bison Mb, whereas Edman degradation was employed to determine the amino acid sequence. Bison and beef myoglobins behaved similarly in autoxidation, lipid oxidation-induced oxidation, and thermostability. The observed molecular mass of bison and beef myoglobins was 16,949 Da, and the primary structure of bison Mb shared 100% similarity with beef and yak myoglobins. Noticeably, the amino acid sequence of bison Mb was different from other ruminant myoglobins, such as water-buffalo, sheep, goat, and red-deer. The present study is the first to report the primary structure of bison Mb. Same primary structure and similar biochemical attributes of bison and beef myoglobins suggested that the observed rapid discoloration in bison meat could not be attributed to biochemistry of bison Mb.

Selective cytotoxic activities of two novel synthetic drugs on human breast carcinoma MCF-7 cells

BACKGROUND

Breast cancer is the second leading cause of cancer deaths in US women. We evaluated two novel compounds, piperidinyl-diethylstilbestrol (DES) and pyrrolidinyl-diethylstilbestrol (DES) for cytotoxicity against brine shrimp larvae, MCF-7 and rat normal liver cells.

MATERIALS AND METHODS

In vivo cytotoxicity was evaluated against shrimp larvae for 24 h, while in vitro cell toxicity was evaluated by dye binding crystal-violet method after 48 h. The role of these compounds on different phases of the cell cycle was assessed by flow cytometry.

RESULTS

In shrimp assay, piperidinyl-DES and pyrrolidinyl-DES were potent with 50% effective dose (ED(50)) values of 7.9+/-0.38 and 15.6+/-1.3 microM, respectively. In MCF-7 and normal liver cells, the 50% lethal concentration (LC(50)) values were 19.7+/-0.95, 17.6+/-0.4 microM and 35.1 and >50 microM, respectively. Cell cycle analyses indicated that MCF-7 cells were arrested at the G(0)/G(1) stage with these compounds.

CONCLUSION

The results indicate that pyrrolidinyl-DES possesses highly selective, potent anticancer activity.

A phase II Brown University Oncology Group study of docetaxel, oxaliplatin, and capecitabine (DOC) for metastatic esophagogastric cancer

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Background: We previously reported results of a phase I study of oxaliplatin, docetaxel, and capecitabine for advanced esophagogastric cancer (Evans et al, Am J C Onc 2007). In this phase II component we describe response rates, toxicity, and survival data. Methods: Patients with histologically confirmed metastatic esophagogastric squamous or adenocarcinoma were eligible. Patients received oxaliplatin 50mg/m2 and docetaxel 35mg/m2 on days 1 and 8 as well as capecitabine 750 mg/m2 twice daily on days 1–10 in each 21 day cycle. Results: 21 patients were enrolled and were evaluable. Median age was 65, range 46–83. All had adenocarcinoma histology. Three patients received prior adjuvant or neoadjuvant therapy. A total of 91 cycles were delivered, median of 4, range of 1–11. Median follow-up was 2 years; all patients have been followed for at least 1 year. Median overall survival was 11 months. The overall response rate was 43%. Three patients achieved a complete response. Two of these patients remain without evidence of disease at 38 and 12 months. Three patients experienced confirmed pulmonary emboli, and one patient expired at home with possible pulmonary embolism (exact cause unknown).Other Grade 3/4 toxicities were: nausea (3/21), fatigue (2/21), diarrhea (4/21), hand/foot (1/21), dehydration (3/21), esophagitis (2/21), infection (1/21), Electrolyte (3/21), neutropenic fever (2/21), neutropenia (4/21), anemia (1/21). Conclusions: DOC is an active and easily administered regimen for metastatic esophagogastric cancer. Consideration should be given for prophylactic anticoagulation for patients with metastatic esophagogastric cancer.

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ASCO Conflict of Interest Policy and Exceptions

In compliance with the guidelines established by the ASCO Conflict of Interest Policy (J Clin Oncol. 2006 Jan 20;24[3]:519–521) and the Accreditation Council for Continuing Medical Education (ACCME), ASCO strives to promote balance, independence, objectivity, and scientific rigor through disclosure of financial and other interests, and identification and management of potential conflicts. According to the ASCO Conflict of Interest Policy, the following financial and other relationships must be disclosed: employment or leadership position, consultant or advisory role, stock ownership, honoraria, research funding, expert testimony, and other remuneration (J Clin Oncol. 2006 Jan 20;24[3]:520). The ASCO Conflict of Interest Policy disclosure requirements apply to all authors who submit abstracts to the Annual Meeting.

For clinical trials that began accrual on or after April 29, 2004, ASCO's Policy places some restrictions on the financial relationships of principal investigators (J Clin Oncol. 2006 Jan 20;24[3]:521). If a principal investigator holds any restricted relationships, his or her abstract will be ineligible for placement in the 2009 Annual Meeting unless the ASCO Ethics Committee grants an exception. Among the circumstances that might justify an exception are that the principal investigator (1) is a widely acknowledged expert in a particular therapeutic area; (2) is the inventor of a unique technology or treatment being evaluated in the clinical trial; or (3) is involved in international clinical oncology research and has acted consistently with recognized international standards of ethics in the conduct of clinical research. NIH-sponsored trials are exempt from the Policy restrictions. Abstracts for which authors requested and have been granted an exception in accordance with ASCO's Policy are designated with a caret symbol (^) in the Annual Meeting Proceedings.

For more information about the ASCO Conflict of Interest Policy and the exceptions process, please visit www.asco.org/conflictofinterest .

Primary structure of goat myoglobin

Color stability attributes of goat meat are different from those of sheep meat, possibly due to species-specific differences in myoglobin (Mb) biochemistry. An examination of post-genomic era protein databases revealed that the primary structure of goat Mb has not been determined. Therefore, our objective was to characterize the primary structure of goat Mb. Goat Mb was isolated from cardiac muscles employing ammonium sulfate precipitation and gel-filtration chromatography, and Edman degradation was utilized to determine the amino acid sequence. Sequence analyses of intact Mb as well as tryptic- and cyanogen bromide-peptides yielded the complete primary structure of goat Mb, which shared 98.7% similarity with sheep Mb. Similar to other livestock myoglobins goat Mb has 153 residues. Comparison of the sequences of goat and sheep myoglobins revealed two amino acid substitutions - THRgoat8GLNsheep and GLYgoat52GLUsheep. Goat Mb contains 12 histidine residues. As observed in other meat-producing livestock species, distal and proximal histidines, responsible for stabilizing the heme group and coordinating oxygen-binding, are conserved in goat Mb.

Cystic artery pseudoaneurysm after laparoscopic cholecystectomy presenting as haemobilia: a case report

Cystic artery pseudoaneurysm which developed following a cholecystectomy and resulting in upper gastrointestinal bleeding is a rare entity, with only three cases described in the literature. We report the case of a 26-year old man who presented with upper gastrointestinal bleeding approximately three months after laparoscopic cholecystectomy. Emergency abdominal angiogram revealed a cystic artery stump pseudoaneurysm, with no evidence of active contrast extravasation. The pseudoaneurysm was coil embolised and the patient had no further bleeding episodes. In this situation an angiogram and embolisation rather than surgery is the preferred mode of management both in terms of diagnosis and treatment. The presence of a dilated cystic artery stump on angiogram following cholecystectomy is an "ominous sign", even in the absence of active extravasation of contrast.

Normal chest radiography in pulmonary tuberculosis: implications for obtaining respiratory specimen cultures

SETTING

Urban tuberculosis (TB) clinic, Nashville, Tennessee, USA.

OBJECTIVE

Chest radiographs (CXRs) help in the diagnosis of pulmonary TB, but may be normal. Mycobacterium tuberculosis in culture is diagnostic of TB, but cultures are not routinely obtained in resource-poor settings. We examined rates and risk factors for pulmonary TB associated with normal CXR.

DESIGN

An observational cohort study was performed among all respiratory culture-positive TB cases referred to the Nashville Health Department from October 1992 to July 2003. Clinical factors, demographics and underlying medical conditions were assessed.

RESULTS

Of 601 study patients, 53 (9%) had normal CXRs: 31/138 (22%) were human immunodeficiency virus (HIV) infected and 22/463 (5%) were non-HIV-infected/unknown (P<0.001). Among HIV-infected patients, normal CXR was more likely in persons with renal failure (13% vs. 3%, P=0.048). Among non-HIV-infected/unknown patients, normal CXR was more likely in those who were asymptomatic at presentation (32% vs. 13%, P=0.022). In multivariable logistic regression analysis, HIV infection was associated with an increased risk of normal CXR (odds ratio [OR] 6.61, P<0.0001); factors associated with reduced risk were dyspnea (OR 0.24, P=0.026), positive sputum smear (OR 0.45, P=0.028) and cough (OR 0.48, P=0.038).

CONCLUSIONS

The rate of normal CXR among persons with culture-confirmed pulmonary TB was high. Respiratory specimen cultures should be obtained in TB suspects with a normal CXR, particularly HIV-infected persons.

Acute parent artery dissection as a complication of mesenteric endovascular coil embolisation for pancreatic pseudoaneurysm

We wish to highlight arterial dissection as an unusual complication during endovascular coiling of a pancreatic pseudoaneurysm. Immediate recognition and prompt corrective measures prevented progression of this serious condition. In our patient, angioplasty prevented further propagation of the dissection and preserved coeliac artery patency.

Comparison of FloTrac™ cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements

BACKGROUND

Arterial pulse waveform analysis has been proposed for cardiac output (CO) determination and monitoring without calibration or thermodilution (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA, USA). The accuracy and clinical applicability of this technology has not been fully evaluated. We designed this prospective study to compare the accuracy of the FloTrac system (CO(FT)) vs. pulmonary artery catheter standard bolus thermodilution (CO(PAC) ) in patients undergoing coronary artery bypass grafting.

METHODS

We studied 11 patients referred for coronary artery bypass grafting. CO(FT) and CO(PAC) were determined at six time points in the operating room including before and 5 min after volume expansion (500 mL 6% hetastarch). Measurements were performed on arrival in the intensive care unit and every 4 h afterwards. Bland-Altman analysis was used to assess the agreement between CO(FT) and CO(PAC).

RESULTS

CO(PAC) ranged from 2.0 to 7.6 L min-1 and CO(FT) ranged from 1.9 to 8.2 L min-1. There was a significant relationship between CO(PAC) and CO(FT) (r = 0.662; P < 0.001). Agreement between CO(PAC) and CO(FT) was -0.26 +/- 0.87 L min-1. Volume expansion induced a significant increase in both CO(PAC) and CO(FT) (from 3.4 +/- 0.8 to 4.4 +/- 1.0 L min-1; P < 0.001 and from 3.9 +/- 1.2 to 5.0 +/- 1.1 L min-1; P < 0.001, respectively) and there was a significant relationship between percent change in CO(PAC) and CO(FT) following volume expansion (r = 0.722; P = 0.01).

CONCLUSION

We found clinically acceptable agreement between CO(FT) and CO(PAC) in this setting. This new device has potential clinical applications.

Prospective, multi-centre clinic-based evaluation of four rapid diagnostic tests for syphilis

OBJECTIVES

To evaluate prospectively four rapid, point-of-care serological tests for syphilis in prenatal or high risk populations in four countries.

METHODS

Tests were performed on consecutive clinic attenders, using whole blood in the clinic, and whole blood and serum in the laboratory. The sensitivity and specificity of each test was evaluated, using a standard treponemal test (Treponema pallidum haemagglutination assay (TPHA) or fluorescent treponemal antibody, absorbed (FTA-ABS) as gold standard. Non-treponemal tests (rapid plasma reagin (RPR) or venereal diseases research laboratory (VDRL) tests) were also performed on all subjects at three sites.

RESULTS

The specificity of each rapid test was >95% at each site. Sensitivities varied from 64-100% and, in most cases, were lower when whole blood was used rather than serum.

CONCLUSIONS

Rapid serological tests for syphilis are an acceptable alternative to conventional laboratory tests. Since they do not require equipment or electricity, they could increase coverage of syphilis screening, and enable treatment to be given at the first clinic visit.

Aciclovir resistance among indian strains of Herpes simplex virus as determined using a dye uptake assay

Resistance to aciclovir (ACV) among Herpes simplex virus (HSV) isolates is increasingly being reported in the literature particularly in immunocompromised patients. However, there is only limited data available from India despite widespread use of ACV in our hospital. A cross-sectional study was hence conducted to determine the aciclovir (ACV) susceptibility of HSV 1 and 2 isolates using a dye uptake (DU) assay. This study showed a 3.0% prevalence of ACV resistance among HSV-1 strains (2/66, median IC 50 0.098 microg/mL) while in HSV-2 strains, it was 7.8% (5/64, median IC 50 0.195 microg/mL). The IC 50 for the HSV-1 and HSV-2 strains resistant to ACV was greater than or equal to 6.25 microg/mL.