Fertility and Pregnancy Outcome after Myoma Enucleation by Minilaparotomy under Microsurgical Conditions in Pronounced Uterus Myomatosus

Introduction: Besides the typical complaints and symptoms, myomas can cause sterility, infertility and complications during pregnancy. Laparoscopic interventions reach their limits with regard to organ preservation and the simultaneous desire to have children in the removal of multiple and larger intramural myoma nodes. The aim of this study is to examine fertility status and pregnancy outcome after myoma removal by minilaparotomy (skin incision maximal 8 cm) in women with pronounced uterus myomatosus. Materials and Methods: This retrospective study makes use of the data from 160 patients with an average age of 34.6 years. Factors analysed include number, size and localisation of the myomas, complaints due to the myoma, pre- and postoperative gravidity, mode of delivery, and complications of birth. Results: Indications for organ-sparing myoma enucleation were the desire to have children (72.5 %), bleeding disorders (60 %) and pressure discomfort (36.5 %). On average 4.95 (SD ± 0.41), maximally 46 myomas were removed. The largest myoma had a diameter of 6.64 cm (SD ± 2.74). 82.5 % of the patients had transmural myomas, in 17.5 % the uterine cavity was inadvertently opened. On average the operating time was 163 minutes (SD ± 45.47), the blood loss 1.59 g/dL (SD ± 0.955). 60.3 % of the patients with the desire to have children became pregnant postoperatively. 75.3 % of the pregnancies were on average carried through to the 38th week (28.4 % vaginal deliveries, 71.6 % Caesarean sections). In the postoperative period there was one case of uterine rupture in the vicinity of a previous scar. Discussion: By means of the microsurgical "mini-laparotomy" even extensive myomatous uterine changes can, in the majority of cases, be operated in an organ-sparing manner with retention of the ability to conceive and to carry a pregnancy through to maturity of the infant. The risk for a postoperative uterine rupture in a subsequent pregnancy and during delivery is minimal.

Attitude toward, acceptance of and knowledge about female sterilization as a method of contraception

OBJECTIVE

Surgical sterilization via tubal ligation or the disconnection of the tubes is a method of permanent contraception. The aim of this study was to evaluate the attitude, acceptance and knowledge of women about female sterilization as a method of contraception in terms of the social and cultural backgrounds of those women.

STUDY DESIGN

Prospective study based on an anonymous questionnaire that analyzed background knowledge, attitude, influence factors and motivation regarding sterilization, as well as the reasons for declining. The questionnaire also attempted to evaluate the effects on the self-esteem of the women, as well as the impact of religious dogma and the related beliefs.

RESULTS

One thousand, eight hundred questionnaires were distributed, and 1247 women completed the questionnaire—a response rate of 69.3%. There were mainly positive attitudes toward sterilization as a contraceptive method. Cultural background, including religion and faith; the mother's experiences and point of view; knowledge; family planning and the actual life situation have an influence on the attitudes toward and acceptance of sterilization as a contraceptive method and on the final choice of a contraceptive method.

CONCLUSION

Cultural background and present life situation have a great impact on the attitude toward and acceptance of sterilization as a method of contraception, thus influencing the final choice of a contraceptive method. Detailed counselling about this topic is essential and should be improved.

Cluster spin glass behavior in geometrically frustrated Zn3V3O8

We report the bulk magnetic properties of a yet unexplored vanadium-based multi-valenced spinel system, Zn3V3O8. A Curie-Weiss fit of our dc magnetic susceptibility χ(T) data in the temperature region of 140-300 K yields a Curie constant C = 0.75 cm(3)K mole(-1) V(-1), θCW = -370 K. We have observed a splitting between the zero field cooled (ZFC) and field cooled (FC) susceptibility curves below a temperature Tirr of about 6.3 K. The value of the 'frustration parameter' (|θcw|/T(N) ~ 100) suggests that the system is strongly frustrated. From the ac susceptibility measurements we find a logarithmic variation of freezing temperature (Tf) with frequency ν attesting to the formation of a spin glass below Tf. However, the value of the characteristic frequency obtained from the Vogel-Fulcher fit suggests that the ground state is closer to a cluster glass rather than a conventional spin glass. We explored further consequences of the spin glass behavior and observed aging phenomena and memory effect (both in ZFC and FC). We found that a positive temperature cycle erases the memory, as predicted by the hierarchical model. From the heat capacity CP data, a hump-like anomaly was observed in CP/T at about 3.75 K. Below this temperature the magnetic heat capacity shows a nearly linear dependence with T which is consistent with the formation of a spin glass state below Tf in Zn(3)V(3)O(8).

Stereotactic body radiotherapy in early stage non-small cell lung cancer: first experience from an Indian Centre

BACKGROUND

Surgery is the standard of care for early stage (T1-2, N0, M0) non-small cell lung cancer. A considerable number of these patients are ineligible for surgery due to age and comorbidities. Hypo fractionated high-dose stereotactic body radiotherapy (SBRT) is being performed for these group of patients. There is paucity of literature regarding this novel technique from the Indian subcontinent.

AIMS AND OBJECTIVES

We hereby report the dosimetry, response and outcome of our small cohort of early stage non-small cell lung cancer patients treated with SBRT.

MATERIALS AND METHODS

Between December 2007 and December 2010, 8 patients of early stage (T1-2N0M0) underwent SBRT at our centre. All the patients had undergone whole body PET-CT scan, MRI brain and pulmonary function test (PFT with DLCO). The SBRT schedules included 48 Gy in 6 fractions for peripherally located and 48 Gy in 8 fractions for centrally located tumors. Response and toxicity were assessed in 3 monthly follow up visits.

RESULTS

The median duration of follow up was 18 months (range 8-44 months). The median age of the patients was 70 years (range 63-82 years) and the median tumor diameter was 4 cm (range 2.8-5.0 cm). The mean PTV volume was 165 cc(range 127.3- 193.9 cc). The mean dose to the PTV was 99.5% (range 97.7- 102.1%). After 3 months, 7 patients had complete metabolic response and 1 patient had partial metabolic response. Overall survival at 1.5 years was 87.5%. One patient had grade 2 pneumonitis. No toxicities of grade 3 or higher were identified.

CONCLUSION

SBRT for early stage NSCLC resulted in excellent local control with minimal toxicity and can be considered as a treatment option in properly selected patients.

Association of dietary factors and other coronary risk factors with social class in women in five Indian cities

The association between social classes, food intake and coronary risk factors was determined. Cross-sectional surveys were conducted in 6-12 urban streets in each of five cities, each one from five different regions of India using similar methods of dietary intakes and criteria of diagnosis. We randomly selected 3257 women aged 25-64 years inclusive, from Moradabad (n = 902), Trivandrum (n = 760), Calcutta (n = 410), Nagpur (n = 405) and Bombay (n = 780). All subjects, after pooling of data, were divided into social class 1 (n = 985), class 2 (n = 790), class 3 (n = 774), class 4 (n = 602) and class 5 (n = 206) based on various attributes of socioeconomic status. Social class 1 was the highest and 5 was the lowest social class. Social classes 1-3 had greater intake of pro-atherogenic foods; total visible fat, milk and milk products, meat and eggs, as well as sugar and confectionery, compared to social classes 4 and 5. The consumption of wheat, rice, millets, fruits, vegetables and legume/total visible fat ratio were inversely associated with social class. Mean body mass index (BMI), obesity, overweight, central obesity and sedentary lifestyle were also significantly more common among subjects from higher social classes. Spearman's rank correlation showed that bodyweight, BMI, wheat, rice, millets, total visible fat, milk and milk products, meat, eggs, sugar and jaggery intakes were significantly correlated with social class. Social class 5 subjects had a lower intake of all foods and a lower BMI, suggestive of a higher rate of undernutrition among them. The findings indicate that the consumption of pro-atherogenic foods and other coronary risk factors are more common in higher social classes compared to lower social classes.

TIMP-2 mutant decreases MMP-2 activity and augments pressure overload induced LV dysfunction and heart failure

Pressure overload induces cardiac extracellular matrix (ECM) remodelling and results in heart failure. ECM remodelling by matrix metalloproteinases (MMPs) is primarily regulated by their target inhibitors, tissue inhibitor of matrix metalloproteinases (TIMPs). It is known that TIMP-2 is highly expressed in myocardium and is required for cell surface activation of pro-MMP-2. We and others have reported that imbalance between angiogenic growth factors and anti-angiogenic factors results in transition from compensatory cardiac hypertrophy to heart failure. We previously reported the pro-angiogenic role of MMP-2 in cardiac compensation, however, the specific role of TIMP-2 during pressure overload is yet unclear. We hypothesize that genetic ablation of TIMP-2 exacerbates the adverse cardiac matrix remodelling due to lack of pro-angiogenic MMP-2 and increase in anti-angiogenic factors during pressure overload stress and results in severe heart failure. To verify this, ascending aortic banding (AB) was created to mimic pressure overload, in wild type C57BL6/J and TIMP-2-/- (model of MMP-2 deficiency) mice. Left ventricular (LV) function assessed by echocardiography and pressure-volume loop studies showed severe LV dysfunction in TIMP-2-/- AB mice compared to controls. Expression of MMP-2, vascular endothelial growth factor (VEGF) was decreased and expression of MMP-9, anti-angiogenic factors endostatin and angiostatin was increased in TIMP-2-/- AB mice compared with wild type AB mice. Connexins (Cx) are the gap junction proteins that are widely present in the myocardium and play an important role in endothelial-myocyte coupling. Our results showed that expression of Cx 37 and 43 was decreased in TIMP-2-/- AB mice compared with corresponding wild type controls. These results suggest that genetic ablation of TIMP-2 decrease the expression of pro-angiogenic MMP-2, VEGF and increases anti-angiogenic factors that results in exacerbated abnormal ventricular remodelling leading to severe heart failure.

A Griffiths-like phase in antiferromagnetic R0.5Eu0.5MnO3 (R = Pr, Nd, Sm)

We report a Griffiths-like phase in isovalent doped rare-earth manganites R(0.5)Eu(0.5)MnO(3) (R = Pr, Nd, Sm). Rietveld refinement of the structural data reveals strong orthorhombic and Jahn-Teller distortions. The dc and ac magnetic studies nicely demonstrate aspects of Griffiths phase-like behaviour. The presence of short range ferromagnetically correlated spin clusters is observed above the antiferromagnetic transition temperature. A disorder driven phase inhomogeneity arising from strong structural distortion is the possible origin of this behaviour.

Superparamagnetic state by linear and non-linear AC magnetic susceptibility in Mn0.5Zn0.5Fe2O4 ferrites nanoparticles

The Mn0.5Zn0.5Fe2O4 nanoparticles has been synthesized using citrate-gel-precursor method. The direct mixing of nitrates and acetates yields homogeneous nanoparticles. Phase formation and crystal structure of the synthesized powder were examined through the X-ray diffraction (XRD). Fourier transform infrared (FTIR) spectra of the sample confirm the spinel structure. The average particle size was determined by transmission electron microscopy (TEM) and field emission scanning electron microscopy (FESEM). The average particle size is found to be about 13 nm. Superparamagnetic-like nature of the nanoparticles of Mn0.5Zn0.5Fe2O4 has been revealed through various dc and linear and non-linear ac magnetization measurements. However, the nanoparticles do not behave like ideal non-interacting superparamagnets. The magnetic particle size is found to be about 8 nm with saturation magnetization about 18.1 emu/g. The blocking temperature (T(B)) of the nanoparticle assembly is found to be about 150 K as observed from dc and ac magnetization measurements. The frequency dependence of the blocking temperature (T(B)) is found to follow Vogel-Fulcher law. The associated characteristic time tau0 is found to be 10(-5) s. This value is different from that generally found for non-interacting superparamagnetic (SPM) systems (tau0 = 10(-9)-10(-10) s).

Comparison study of clinicoradiological profile of primary lung cancer cases: an Eastern India experience

CONTEXT

According to the first population-based cancer registry from eastern part of India, Kolkata and its surrounding areas have the highest prevalence of lung cancer in India. However, there is very limited data from this part of the country.

AIMS

The aim of this study is to find out the demographic and clinicoradiological profile of primary bronchogenic carcinoma.

SETTINGS AND DESIGN

This is a retrospective review of lung cancer cases diagnosed in two tertiary institutes of Kolkata over a period of 4 years.

MATERIALS AND METHODS

We have reviewed the cases with proven histological or cytological diagnosis of primary bronchogenic carcinoma and chi-square test is done to calculate statistical significance.

RESULTS

Out of 607 patients, male 489 and female 118, 67.7% are from rural area, 67.2% are smoker and only 9.4% are ≤40 years of age. Smoking is the major risk factor for primary lung cancer (P = 0.000) but no significance could be established with the different histological subtypes (P = 0.207). Though squamous cell carcinoma (SCC) is the most predominant variety (35.1%), adenocarcinoma and undifferentiated type are overrepresented in ≤40 years. SCC occurs at a significantly higher age group (60.84 ± 12.16 years) than other subtypes (P = 0.000). At least 55.2% cases of nonsmall cell lung cancer and 54% of small cell lung cancer presented in very advanced stage.

CONCLUSIONS

SCC is the most common histological subtype of primary bronchogenic carcinoma. The relatively increased frequency of adenocarcinoma in our study as compared to other studies from India is probably due to higher proportion of nonsmokers.

Size-dependent electronic-transport mechanism and sign reversal of magnetoresistance in Nd0.5Sr0.5CoO3

A detailed investigation of electronic-transport properties of Nd(0.5)Sr(0.5)CoO(3) has been carried out as a function of grain size ranging from micrometre order down to an average size of 28 nm. Interestingly, we observe a size induced metal-insulator transition in the lowest grain-size sample while the bulk-like sample is metallic in the whole measured temperature regime. An analysis of the temperature dependent resistivity in the metallic regime reveals that the electron-electron interaction is the dominating mechanism while other processes like electron-magnon and electron-phonon scatterings are also likely to be present. The fascinating observation of enhanced low temperature upturn and minimum in resistivity on reduction of grain size is found due to electron-electron interaction (quantum interference effect). This effect is attributed to enhanced disorder on reduction of grain size. Interestingly, we observe a cross over from positive to negative magnetoresistance in the low temperature regime as the grain size is reduced. This observed sign reversal is attributed to enhanced phase separation on decreasing the grain size of the cobaltite.

Isolated tubercular splenic abscess: can we defer splenectomy? Our single experience with anti-tuberculous therapy alone

Isolated splenic tuberculosis is an exceedingly rare clinical condition. Microbiological confirmation of diagnosis in such cases is quite difficult. We encountered the case of a 35-year-old female, who presented with persistent low-grade fever and weight loss. The CT scan of the abdomen revealed multiple hypodense splenic lesions. No primary focus of infection was detected in any other organs. Fine needle aspiration of splenic lesion revealed acid-fast bacilli on Ziehl-Neelsen stain. With anti-tuberculous therapy, the lesions regressed significantly in size. We stress that splenic tuberculosis should be considered as a diagnostic possibility even in immunocompetent individuals and choose combination antituberculous therapy as the first line treatment with consideration of splenectomy depending on response.

Observation of Griffiths phase in antiferromagnetic La(0.32)Eu(0.68)MnO3

We report the Griffiths phase (GP) scenario for isovalent doping in antiferromagnetic La(0.32)Eu(0.68)MnO(3). Rietveld refinement of structural data displays strong crystal structural distortion. The dc and ac magnetic studies nicely demonstrate unambiguous aspects of robust GP. The presence of ferromagnetically correlated spin clusters is found above the transition temperature, T(N). The disorder-driven phase inhomogeneity is correlated to strong structural distortion, giving rise to the GP. This is an unique example in manganite where double exchange interaction does not play any role for the observed phenomenon.

Metallicity and ferromagnetism in nanosystem of charge ordered Nd0.5Sr0.5MnO3

The fascinating phenomenon of destabilization of charge/orbital order in Nd0.5Sr0.5MnO3 with the reduction of grain size is critically investigated. Based on our magnetic and transport experiments followed by a theoretical analysis, we analyze various possible mechanisms and try to delineate a universal scenario behind this phenomenon. We revisit this issue carefully and discuss various evidences from experiments in nano and bulk manganites on the absence of correlation between size reduction and pressure effects on manganites. We propose a phenomenological model based on enhanced surface disorder to explain the appearance of weak ferromagnetism and metallicity in nanosize Nd0.5Sr0.5MnO3 system. All evidence seems to suggest that the transport is mediated through the surface via enhanced density of states in the nanometric grains. We provide theoretical support for this by performing an ab-initio electronic structure calculation as well as from a recent numerical simulation and argue that the mechanism is likely to be general in all nanosize charge ordered manganites.

Pulmonary disease due to Mycobacterium massiliense

We report a case of a patient suffering from multidrug-resistant pulmonary tuberculosis (MDR-PTB) who later developed an invasive infection of the respiratory tract with a rapidly growing non-tuberculous mycobacteria (NTM), recently identified as Mycobacterium massiliense, closely related to M. abscessus. To the best of our knowledge, this is the first case of M. massiliense infection being reported from India.

The evolution of the Indian Ocean parrots (Psittaciformes): extinction, adaptive radiation and eustacy

Parrots are among the most recognisable and widely distributed of all bird groups occupying major parts of the tropics. The evolution of the genera that are found in and around the Indian Ocean region is particularly interesting as they show a high degree of heterogeneity in distribution and levels of speciation. Here we present a molecular phylogenetic analysis of Indian Ocean parrots, identifying the possible geological and geographical factors that influenced their evolution. We hypothesise that the Indian Ocean islands acted as stepping stones in the radiation of the Old-World parrots, and that sea-level changes may have been an important determinant of current distributions and differences in speciation. A multi-locus phylogeny showing the evolutionary relationships among genera highlights the interesting position of the monotypic Psittrichas, which shares a common ancestor with the geographically distant Coracopsis. An extensive species-level molecular phylogeny indicates a complex pattern of radiation including evidence for colonisation of Africa, Asia and the Indian Ocean islands from Australasia via multiple routes, and of island populations 'seeding' continents. Moreover, comparison of estimated divergence dates and sea-level changes points to the latter as a factor in parrot speciation. This is the first study to include the extinct parrot taxa, Mascarinus mascarinus and Psittacula wardi which, respectively, appear closely related to Coracopsis nigra and Psittacula eupatria.

Young male with systemic lupus erythematosus presenting with sensorineural deafness with immune suppression induced miliary tuberculosis

A 32 year male presented with deafness and other classical symptoms suggestive of SLE. Subsequent serological investigations confirmed the diagnosis. Renal biopsy showed the presence of SLE induced Grade V nephropathy. Patient was started on NIH protocol for lupus nephritis on which he was doing well. After two years, he presented with symptoms of miliary tuberculosis and was started on ATD. Subsequently, he developed ATD induced hepatotoxicity and had to be switched over to Inj. Streptomycin containing regimen. We thought to share this clinical experience, as we found it a challenge to manage tuberculosis in such a setting, where a fine balance had to be maintained between immunosuppression for SLE and therapy of TB, and an ototoxic drug had to be used in a patient with deafness induced by SLE.

Evolutionary history and identification of conservation units in the giant otter, Pteronura brasiliensis

The giant otter, Pteronura brasiliensis, occupies a range including the major drainage basins of South America, yet the degree of structure that exists within and among populations inhabiting these drainages is unknown. We sequenced portions of the mitochondrial DNA (mtDNA) cytochrome b (612bp) and control region (383 bp) genes in order to determine patterns of genetic variation within the species. We found high levels of mtDNA haplotype diversity (h = 0.93 overall) and support for subdivision into four distinct groups of populations, representing important centers of genetic diversity and useful units for prioritizing conservation within the giant otter. We tested these results against the predictions of three hypotheses of Amazonian diversification (Pleistocene Refugia, Paleogeography, and Hydrogeology). While the phylogeographic pattern conformed to the predictions of the Refugia Hypothesis, molecular dating using a relaxed clock revealed the phylogroups diverged from one another between 1.69 and 0.84 Ma, ruling out the influence of Late Pleistocene glacial refugia. However, the role of Plio-Pleistocene climate change could not be rejected. While the molecular dating also makes the influence of geological arches according to the Paleogeography Hypothesis extremely unlikely, the recent Pliocene formation of the Fitzcarrald Arch and its effect of subsequently altering drainage pattern could not be rejected. The data presented here support the interactions of both climatic and hydrological changes resulting from geological activity in the Plio-Pleistocene, in shaping the phylogeographic structure of the giant otter.

Evidence of electronic phase arrest and glassy ferromagnetic behaviour in (Nd(0.4)Gd(0.3))Sr(0.3)MnO3 manganite: comparative study between bulk and nanometric samples

The effect of the doping of rare earth Gd(3+) ions replacing Nd(3+) in Nd(0.7)Sr(0.3)MnO(3) is investigated in detail. Measurements of resistivity, magnetoresistance, magnetization, and linear and nonlinear ac magnetic susceptibility on chemically synthesized (Nd(0.7-x)Gd(x))Sr(0.3)MnO(3) show various interesting features with doping level x=0.3. A comparative study has been carried out between a bulk and a nanometric sample (grain size ∼60 nm) synthesized from the same as a prepared powder to maintain an identical stoichiometry. The resistivity of the samples shows strong dependence on the magnetic field-temperature history. The magnetoresistance of the samples also shows strong irreversibility with respect to sweeping of the field between the highest positive and negative values. Moreover, the resistivity is found to increase with time after field cooling and then switching off the field. All these phenomena have been attributed to phase separation effects and the arrest of phases in the samples. Furthermore, the bulk sample displays a spin glass like behaviour as evident from the frequency dependence of linear ac magnetic susceptibility and critical divergence of the nonlinear ac magnetic susceptibility. The experimentally obtained characteristic time τ(0) after dynamical scaling analysis of the frequency dependence of the ac susceptibility is found to be 10(-17) s which implies that the system is different from a canonical spin glass. An unusual frequency dependence of the second harmonic of ac susceptibility around the magnetic transition temperature led us to designate the magnetic state of the sample to be glassy ferromagnetic. On reduction of the grain size low field magnetoresistance and phase arrest phenomena are found to enhance but the glassy state is observed to be destabilized in the nanometric sample.

Clinical effectiveness and safety of gemifloxacin versus cefpodoxime in acute exacerbation of chronic bronchitis: A randomized, controlled trial

Objective:

Acute exacerbation of chronic bronchitis (AECB) is a commonly encountered problem and those suspected to be due to bacterial infections require antibiotic therapy. This randomized, controlled trial was designed to evaluate the effectiveness and safety of gemifloxacin, a new fluoroquinolone, versus cefpodoxime, an oral third-generation cephalosporin, for the treatment of mild to moderately severe cases of AECB.

Materials and Methods:

Adult subjects diagnosed with chronic bronchitis with clinical symptoms suggestive of an Anthonisen type II acute exacerbation (any two of the following criteria – increased dyspnea, cough, sputum purulence) were eligible and those fulfilling the subject selection criteria were randomized to receive either gemifloxacin 320 mg once daily or cefpodoxime 200 mg twice daily orally for 7 days. The primary outcome measure was clinical success rate at day 14 visit and the secondary outcome measures were changes in Clinical Global impression (CGI) scales and incidence of adverse events (AEs). Fifty-two subjects were enrolled: 26 in gemifloxacin group and 24 in the other and 2 were lost to follow-up.

Results:

The clinical success rates were comparable (84.6% in gemifloxacin group versus 83.3% in cefpodoxime group) and no statistically significant difference was observed between the groups. AEs were mild, self-limiting and few (two in gemifloxacin and three in cefpodoxime arm) and tolerability was also good.

Conclusion:

The results of this randomized, single-blind trial demonstrated that a 7-day course of gemifloxacin is therapeutically comparable to cefpodoxime in terms of both clinical effectiveness and safety for the treatment of type II Anthonisen category AECB patients.

Cellulose-based liquid crystalline photoresponsive films with tunable surface wettability

We report on a new type of liquid crystalline cellulosic films with light controllable reversible wettability. The films are prepared from a thermotropic cellulose derivative functionalized with azo-containing groups. These groups exhibit dynamic changes in interfacial properties in response to UV irradiation. The UV irradiation induces trans-to-cis isomerization in the azobenzene moiety, which causes a conformational change in the upper molecular layers of the thin films. These changes originate a hydrophobic to comparatively hydrophilic transformation of the surface. The reversible wettability of the surface results from the cis/trans photo and thermal isomerization. The UV-vis absorption spectra, as well as contact angle measurements with UV irradiation, clearly support the understanding of the phenomenon. This type of surface design enables the amplification of molecular level conformational transitions to macroscopic changes in interface properties using the means of isomerism. This opens new opportunities in surface engineering using eco-friendly cellulose manipulation.

Metastatic pleural effusion: a rare presentation of salivary gland adenoid cystic carcinoma

Adenoid cystic carcinoma, an uncommon malignant salivary gland neoplasm, is known for its long clinical course, indolent growth, local recurrence and late distant metastasis. We report an unusual case of adenoid cystic carcinoma of the palate in a 64-year-old woman, undiagnosed for more than 15 years, who presented as malignant pleural effusion.

GSTT1 and GSTM1 gene deletions are not associated with hepatotoxicity caused by antitubercular drugs

BACKGROUND AND OBJECTIVE

Susceptibility to antitubercular drug (ATD)-induced hepatotoxicity may be genetically mediated, with variant alleles of genes such as N-acetyltransferase (NAT2) and CYP2E1 reported as risk factors. Two studies of Asian populations have reported that GSTM1*0 ⁄ *0 (null) genotype was a likely predictor of hepatotoxicity, whereas another of a Caucasian population implicated GSTT1*0 ⁄ *0. We undertook a prospective case-control study to investigate whether GSTM*0 ⁄ *0 and GSTT1*0 ⁄ *0 were risk factors for ATD-induced hepatotoxicity.

METHODS

Pulmonary tuberculosis patients on isoniazid, rifampicin and pyrazinamide who developed hepatotoxicity using defined criteria were prospectively identified. These cases were then matched with at least one control subject on the same drugs but without hepatotoxicity. Genotyping for GSTM1 and GSTT1 was performed by multiplex PCR on genomic DNA. The odds ratios for the frequency of specific GSTM1 and GSTT1 homozygotes in the case and control subjects were calculated to test for association between the genotypes and hepatotoxicity.

RESULTS AND DISCUSSION

Hundred and fifty-one subjects (51 cases, 100 controls) were enrolled. Odds ratio for GSTM1 null genotype was 1.00 (95% CI 0.51-1.97) and GSTT1 null was 2.02 (95% CI 0.39-10.39), respectively, showing that these genotypes are not associated with hepatotoxicity.

CONCLUSION

GSTM1 *0 ⁄ *0 or GSTT1 *0 ⁄ *0 or both null genotypes, do not appear to be associated with ATD-induced hepatotoxicity in our Indian population.

Size-induced metallic state in nanoparticles of ferromagnetic insulating Nd0.8Sr0.2MnO3

A detailed investigation of the electronic- and magneto-transport properties of Nd(0.8)Sr(0.2)MnO(3) with the variation of grain size (down to 42 nm) is presented here. Interestingly, we observe that the ferromagnetic insulating state is suppressed and a metallic state is stabilized as the grain size of the sample is reduced. As a result, a metal-insulator transition is observed in this low doped manganite which is insulating in nature in its bulk form. Destabilization of polaronic order in the ferromagnetic insulating state due to enhanced surface disorder on grain size reduction is attributed to this effect. A phenomenological model is proposed to represent the concept of destabilization of polaron formation in the surface region of the nanograins. Resistivity and magnetoresistance data are carefully analysed employing different suitable models. Electrical third harmonic resistance is measured to directly probe the electrical nonlinearity in the samples.

Mediastinal hydatid disease: an unusual presentation

Hydatid disease is a significant health problem in endemic areas. While occurrence of the cysts in the liver and lung is common, mediastinal localisation is extremely rare. We report the case of a 35-year-old male who presented with a painless swelling on the right side of the neck and features of superior vena caval obstruction. Chest radiography and computed tomography (CT) suggested a cyst in the right upper lobe, extending into the right supraclavicular region as well as another cyst in the left lung. Thoracotomy revealed that the right-sided cyst was actually mediastinal in location and had herniated through the thoracic inlet compressing the superior vena cava (SVC). Both cysts were removed in two separate operations and symptoms of SVC compression subsided after removal of the right-sided cyst. Histopathology was consistent with a hydatid disease.