Prevention of beta-thalassemia in a large Pakistani family through cascade testing

BACKGROUND

We report cascade testing of a large Pakistani family for beta-thalassemia alleles. The family was still practicing consanguineous marriages and was at risk of having more affected births.

OBJECTIVE

The objective of this study was to show that identification of disease carriers in families with index cases in order to create awareness about disease and provide genetic counseling would result in reduction of the frequency of beta-thalassemia in Pakistan.

METHODS

In this large family with an index case, 27 available living members were tested for beta-thalassemia. Carriers of the disease were detected by measuring hemoglobin indices, and amplification refractory mutation system polymerase chain reaction was used for mutation analysis. Genetic counseling was provided to members of this family.

RESULTS

There were already 3 marriages between the carrier members and 1 between a carrier and noncarrier in this large family; 12 (44.4%) members were found to carry the mutant gene, representing a very high carrier rate compared to the 5.4% carrier frequency of beta-thalassemia in the general population of Pakistan. The family was counseled for prevention of affected births. The initially reluctant family gradually became cooperative and seriously attended the genetic counseling sessions.

CONCLUSION

Cascade testing is more practical than general population screening in a country with limited health facilities where consanguineous marriages are practiced. This report emphasizes the need of extensive testing within families with index cases to identify the carriers of beta-thalassemia in order to reduce disease occurrence through awareness and genetic counseling.

A practical profile of integrated safety assessment of near-surface disposal of radwaste at PINSTECH

Near-surface or shallow land disposal of radioactive waste has been the primary practice at the Pakistan Institute of Nuclear Science and Technology (PINSTECH). The adopted choice of this mode of disposal has been based on a study of the site and the quality and quantity of waste generated at the 5 MW reactor with HEU fuel. Specific measures regarding the radiation safety of the workers and environmental protection have been adopted. The waste disposal operations are conducted to meet local regulatory requirements, IAEA recommendations and internationally endorsed principles such as ALARA (as low as reasonably achievable - economic, social and other relevant factors being considered). The data obtained through the years of operational and management experience have manifested the robustness of the disposal system and reliability of the disposal criterion, and have also served to further refine the latter. Consequently, confidence in the current shallow-land-burial practices has increased. Radiological safety of these practices has been assessed by addressing different aspects of the safety and disposal system. These parameters, as indices of a non-exclusive and operational safety model, are presented.

Synthesis of Amine-stabilized Aqueous Colloidal Iron Oxide Nanoparticles

We demonstrate a simple one-step process for the synthesis of iron oxide nanoparticle aqueous colloids using the multifunctional molecule, dodecylamine (DDA), that electrostatically complexes with aqueous iron ions (one precursor Fe(2+) from FeCl(2)), reduces them, and subsequently caps the nanoparticles. The iron oxide particles thus synthesized are of the face-centered cubic (FCC) phase with high degree of monodispersity with appropriate concentration of amine capping molecular layer. The aqueous magnetic nanocrystalline colloids were characterized by TEM, XRD, XPS, TGA/DTA and FTIR spectroscopy techniques. The relaxivity, stability, and hydrodynamic size of the nanoparticles were investigated for potential application in magnetic resonance imaging (MRI). The magnetic properties were also studied by using a superconducting quantum interference device (SQUID) magnetometer at room temperature. We believe that such simple one-step synthesis of biocompatible aqueous nanomagnetic colloids will have viable applications in biomedical imaging, diagnostics and therapeutics.

Peripheral arterial revascularization causing parallel increased activity of pro- and anti-inflammatory mediators

AIM

The aim of this study was to investigate the interaction between the proinflammatory mediator interleukin (IL)-6 and anti-inflammatory mediator IL-10 in ischemia reperfusion injury following peripheral arterial revascularization.

METHODS

Three groups of patients were recruited (group 1: femoral angiography alone [n=14]; group 2: radiologically successful ilio/femoral angioplasty [n=10]; and group 3: peripheral surgical bypass [n=11]). Peripheral venous blood obtained for all patients at pre-procedure and at 1 h and 24 h post-procedure. After centrifugation supernatant plasma was separated and analysed for proinflammatory cytokine IL-6 and anti-inflammatory cytokine IL-10 using enzyme linked immunosorbent assay (ELISA) technique.

RESULTS

Levels of IL-6 at 1 and 24 h were significantly higher in group 3 (P<0.05 and P<0.01, respectively) and at 24 h in group 2 as compared to group 1 (P<0.05). Levels of IL-10 were significantly higher in group 3 at 24 h (P<0.05). In group 2 levels of IL-10 higher than group 1, but this did not reach statistical significance (P=0.07).

CONCLUSIONS

Raised levels of IL-6 at 1 and 24 h in patients undergoing operative peripheral bypass suggest early and persistent proinflammatory activity, similarly patients with successful angioplasty also demonstrated similar persistent proinflammatory activity of IL-6 at 24 h. Raised levels of IL-10 at 24 h represents anti-inflammatory properties of IL-10 counter acting inflammatory response.

Extracellular ATP induces assembly and activation of the myosin light chain phosphatase complex in endothelial cells

OBJECTIVES

Extracellular ATP stabilizes the endothelial barrier and inactivates the contractile machinery of endothelial cells. This inactivation relies on dephosphorylation of the regulatory myosin light chain (MLC) due to an activation of the MLC phosphatase (MLCP). To date, activation and function of MLCP in endothelial cells are only partially understood.

METHODS

Here, the mechanism of extracellular ATP-mediated activation of MLCP was analyzed in human endothelial cells from umbilical veins. Cells were transfected with the endogenous protein phosphatase 1 (PP1)-specific inhibitor-2 (I-2).

RESULTS

Overexpression of I-2 led to inhibition of PP1 activity and abrogation of the ATP-induced dephosphorylation of MLC. This indicates that the PP1 catalytic subunit is the principal phosphatase catalyzing the MLC dephosphorylation induced by extracellular ATP. As demonstrated by immunoprecipitation analysis, extracellular ATP recruits the PP1delta catalytic subunit and the myosin phosphatase targeting subunit (MYPT1) to form a complex. ATP stimulated dephosphorylation of MYPT1 at the inhibitory phosphorylation sites threonine 850 and 696. However, extracellular ATP failed to stimulate MYPT1 dephosphorylation in I-2-overexpressing cells.

CONCLUSIONS

The present study shows for the first time that, in endothelial cells, extracellular ATP causes activation of MLCP through recruitment of PP1delta and MYPT1 into a MLCP holoenzyme complex and PP1-mediated reduction of the inhibitory phosphorylation of MYPT1.

Pre-operative Radial Arterial Diameter Predicts Early Failure of Arteriovenous Fistula (AVF) for Haemodialysis

INTRODUCTION

Long term patency of arteriovenous fistula (AVF) is relevant to the management of end stage renal failure (ESRF) patients on haemodialysis (HD). We evaluated the role of routine radial arterial duplex for imaging radial artery before AVF formation to investigate the relationaship between radial artery internal diameter (ID) and AVF patency.

METHODS

21 patients with ESRF were examined by duplex sonography before AVF formation, 1 day, 1 week, 4 week and 12 weeks post AVF formation. For assessment of AVF patency, patients were divided into 2 groups. Group-1, 11 patients with radial artery ID <1.5mm and Group-2, 10 patients with radial artery ID >1.5mm. Measurement of radial artery blood inflow rate was calculated from mean blood flow velocity and vessel diameter. All AVFs were constructed on the forearm using autologous veins.

RESULTS

In Group-1, 5 patients (45%) showed immediate thrombosis of AVF graft. All patients in group-2 had patent AVF at 12 weeks. Pre-AVF formation radial artery blood inflow rate between two groups was not significantly different (p=0.06). Radial artery blood inflow rate was consistently and significantly higher in group-2 at all later time points with p value of <0.01 (Mann Whitney test).

CONCLUSION

There was a high failure rate of AVF with radial artery ID of <1.5mm. In the presence of small radial arteries primary access AVF in the upper arm should be considered.

Silica encapsulation and magnetic properties of FePt nanoparticles

Core-shell nanoparticles have emerged as an important class of functional nanostructures with potential applications in many diverse fields, especially in health sciences. We have used a modified aqueous sol-gel route for the synthesis of size-selective FePt@SiO2 core-shell nanoparticles. In this approach, oleic acid and olyel amine stabilized FePt nanoparticles are first encapsulated through an aminopropoxysilane (APS) monolayer and then subsequent condensation of triethoxysilane (TEOS) on FePt particle surface. These well-defined FePt@SiO2 core-shell nanoparticles with narrow size distribution become colloidal in aqueous media, and can thus be used as carrier fluid for biomolecular complexes. In comparison, the scarce hydrophilic nature of oleic acid monolayers on FePt particle surface yields an edgy partial coating of silica when only TEOS is applied for the surface modification. The synthesized core-shell nanoparticles were characterized by direct techniques of high resolution transmission electron microscopy (HRTEM), EDS and indirectly via UV-vis absorption and FTIR studies. The FePt@SiO2 nanoparticles exhibit essential characteristics of superparamagnetic behavior, as investigated by SQUID magnetometry. The blocking temperatures (T(B)) of FePt and FePt@SiO2 (135 and 80 K) were studied using zero field cooled (ZFC)/field cooled (FC) curves.

Unilateral multicystic dysplastic kidney: long term outcomes

AIMS

To report the long term follow up of children with antenatally detected unilateral multicystic dysplastic kidney (MCDK) with documentation of complications, involution rate with time, and renal function at 10 years.

METHODS

Data were retrieved from a prospective regional registry of patients with MCDK between 1985 and 2004. Children were followed using a common protocol of investigation with follow up ultrasound scans (USS) at 2 (165 patients), 5 (117 patients), and 10 years (43 patients).

RESULTS

Serial USS showed that 33% of the MCDK kidneys had completely involuted at 2 years of age, 47% at 5 years, and 59% at 10 years. No patients developed hypertension, significant proteinuria, or malignancy, but two developed pelviureteric junction obstruction in the contralateral kidney. Twenty seven of 143 children (19%) had vesicoureteric reflux (VUR) (96% mild to moderate VUR) into the contralateral kidney with no difference in the incidence of urinary tract infections or renal scarring between those with or without VUR. The mean estimated glomerular filtration rate (GFR) was 86.4 ml/min/1.73 m2 (range 48-125) in 31 of 43 patients followed to 10 years.

CONCLUSIONS

Conservative management of unilateral MCDK is justified with clinical review and infrequent USS but longer term follow up continues in the 41% still with renal remnants at 10 years and those with impaired GFR. It is suggested that the initial micturating cystogram is deferred unless abnormal USS features are present in the contralateral kidney or ureter.

Effect of pesticide residues on health and different enzyme levels in the blood of farm workers from Gadap (rural area) Karachi-Pakistan

Persons from 14 different fruit and vegetable farm stations from Gadap (rural area), Karachi-Pakistan were examined for the presence of pesticide (cypermethrin, deltamethrin, polytrin-C, diazinon, monocrotophos, DDT and DDE) residues in their blood samples. The present study is concerned with effects of residue on the enzyme levels (GPT, GOT and ALP) as well as the health hazards of pesticide exposed persons. There is a significant increased in the enzyme levels at different stations. Exposed persons complained about liver and kidney dysfunctions and RTI. It may be concluded that exposure of multiple pesticides for prolonged period has affected the normal functioning of different organ systems and possibly produced characteristics clinical effects such as hepatitis, dyspnea and burning sensation in urine.

Calf muscle pump failure in lower limb lymphoedema

Abnormal venous haemodynamics and poor calf muscle pump may play a role in lymphoedema by contributing to production of excess interstitial fluid. Using photoplethysmography (PPG), we compared haemodynamic characteristics between normal and lymphoedematous lower limbs. PPG was performed using an automated infrared-based system, while the patient performed 10 active dorsiflexions of the ankle. This gave values for venous refilling time and venous pump power. A total of 62 limbs (normal = 37; lymphoedematous = 25) were studied. Lymphoedematous limbs showed significantly decreased venous pump power and venous refilling time (s) than normal limbs (24.6±14.1 versus 45.4±16 and 23±15.2 versus >45, respectively; P<0.005 for all the results). The haemodynamic values measured in the normal group showed good consistency and reproducibility. These results were consistent with the previous literature and demonstrate an impaired venous system associated with the development of lymphoedema. Poor muscle pump power may reflect physical disability of the ankle joint to perform dorsiflexion. This factor should be considered when treating this incurable condition.

Stroke-associated pneumonia: microbiological data and outcome

INTRODUCTION

Pneumonia is a common complication after acute stroke. It affects the outcome adversely. However, data regarding microbiology of stroke-associated pneumonia and its effect on outcome is scarce.

METHODS

Stroke-associated pneumonia was identified through chart review of all ICD-9 identified adult stroke patients admitted to our hospital over a period of four years (1998-2001). The demographical, laboratory, radiological, microbiological data and outcome of patients with stroke-associated pneumonia were recorded and analysed.

RESULTS

443 patients with stroke were admitted over the four-year period and 102 (23 percent) had stroke-associated pneumonia. Their ages range from 28 to 100 (mean 64+/-14) years. 69 (68 percent) were men. Median length of stay was nine days compared to four days for all stroke patients. 68 (67 percent) patients manifested pneumonia within 48 hours and 34 (33 percent) after 48 hours of admission. Yield of tracheal aspirate cultures was 38 percent and that of chest radiographs was 25 percent. Pseudomonas aeruginosa and Staphylococcus aureus were the most common organisms (12 percent each) followed by Streptococcus pneumoniae and Klebsiella pneumoniae (4 percent each). Patients with infiltrates on chest radiographs were more likely to have positive tracheal aspirate cultures (p-value is 0.003). 35 patients (34 percent) expired during hospital stay. Positive chest radiographs and tracheal aspirates were independent predictors of prolonged hospital stay (p-value is less than 0.005).

CONCLUSION

Pneumonia is a common medical complication of stroke. It is associated with a high mortality and prolongs the hospital stay. The yield of chest radiographs and tracheal aspirates is low. However, these are independent predictors of prolonged hospital stay. Pseudomonas aeruginosa and Staphylococcus aureus are most common organisms in stroke-associated pneumonia.

Gastroprotective effect of cardamom, Elettaria cardamomum Maton. fruits in rats

Cardamom, the fruits of Elettaria cardamomum Maton. (Zingiberaceae) commonly known as "Heel khurd" is used in Unani system of medicine to treat gastrointestinal disorders. A crude methanolic extract (TM), essential oil (EO), petroleum ether soluble (PS) and insoluble (PI) fractions of methanolic extract, were studied in rats at doses of 100-500, 12.5-50, 12.5-150 and 450 mg/kg, respectively for their ability to inhibit the gastric lesions induced by aspirin, ethanol and pylorous ligature. In addition their effects on wall mucus and gastric acid output were recorded. All fractions (TM, EO, PS, PI) significantly inhibited gastric lesions induced by ethanol and aspirin but not those induced by pylorus ligation. TM proved to be active reducing lesions by about 70% in the EtOH-induced ulcer model at 500 mg/kg. The PS fraction reduced the lesions by 50% at 50 and 100mg/kg (no dose response was observed) with similar effect than the PI fraction at 450 mg/kg. In the aspirin-induced gastric ulcer, the best gastroprotective effect was found in the PS fraction, which inhibited lesions by nearly 100% at 12.5mg/kg. In our experimental conditions, the PS extract at doses >or=12.5mg/kg proved to be more active than ranitidine at 50mg/kg.

Radiation protection aspects of shallow land disposal of low and intermediate level liquid and solid radioactive waste at PINSTECH

Operation of Pakistan Research Reactors 1 and 2, radioisotope production plants, and allied laboratories at the Pakistan Institute of Nuclear Science & Technology (PINSTECH) generates radioactive waste effluents of low and intermediate level. These waste materials are managed in a way to keep the human health and the environment free of radiation associated hazards. The prime practice has been of shallow ground or near-surface disposal type. Different measures and operational procedures at the institute, in step with the international norms for the management of low and intermediate level waste, have been adopted. To ensure the safe disposal practices and radiation safety of the workers and of the general public, radiological safety related routines are practiced with due concern. Some safety aspects of the prevailing practices are discussed in this presentation.

Ochratoxin A blood concentration in healthy subjects and bladder cancer cases from Pakistan

ASTRACT: The mycotoxin ochratoxin A (OTA) is a public health issue in many countries. Data on OTA concentrations in foods and in blood are available for several European countries including the Balkan area, as well as for Canada and Japan. Yet, for developing countries such data are scarce. In this study we determined OTA blood levels as biomarker of exposure in bladder cancer patients and in healthy controls from Pakistan. OTA in blood was analyzed after extraction by HPLC with fluorescence detection (limit of detection: <0.03 ng/mL) in 96 patients and in 31 controls. Over 92% of all blood samples (87 patients, 30 controls) contained quantifiable amounts of OTA: The mean OTA concentrations were 0.33 ng/mL (SD 0.42; range: 0.03 to 3.41 ng/mL) in bladder cancer patients, and 0.31 ng/mL (SD 0.29; range: 0.04 to 1.25 ng/mL) in healthy controls. These OTA concentrations are comparable to those reported for the general population in the European Union.

Failure of conservative management after the passage of a distal colonic "cast": report of a case

PURPOSE

The spontaneous passage per rectum of a full-thickness colon "cast" is a rare consequence of acute colonic ischemia. Previous cases have undergone surgery soon afterward because of intractable symptoms. We report a patient who was managed conservatively for 11 months but ultimately required definitive surgery.

METHODS

The clinical, radiographic, pathologic, and endoscopic findings were obtained from the case notes and compared with previously reported cases.

RESULTS

A 67-year-old obese patient underwent a Hartmann's procedure for a perforated diverticular abscess, which was reversed six months later. On the first postoperative night after the reversal, she had a brief hypotensive episode, and three weeks later passed a 21-cm, full-thickness infarcted piece of colon. She did not develop peritonitis and for 11 months experienced only mild symptoms. Under colonoscopic surveillance, the granulation tissue conduit connecting the remaining viable bowel became increasingly stenosed proximally and difficult to dilate. After three rapidly consecutive episodes of large-bowel obstruction, she required a laparotomy to resect the stricture and restore bowel continuity. From a literature review, this is the eighth case of its kind and the first in which such prolonged conservative management has been possible.

CONCLUSIONS

When symptoms permit, it is feasible to manage patients conservatively in the short-term after this unusual event to allow recovery from the initial insult and planning of future surgery. However, definitive treatment is surgical and colonoscopic management should not delay this once the patient is fit for surgery.

Genetic diversity of Escherichia coli recovered from the oral cavity of beef cattle and their relatedness to faecal E. coli

AIMS

To determine the genetic diversity of generic Escherichia coli recovered from the oral cavities of beef cattle and their relatedness to E. coli isolated from the faeces of cattle during pasture grazing and feedlot finishing.

METHODS AND RESULTS

A total of 484 E. coli (248 oral and 236 faecal isolates) were obtained from eight beef cattle after 1 and 5 months of grazing on pasture and after 1 and 5 months in a feedlot. The random amplification of polymorphic DNA (RAPD) method was used to genetically characterize these isolates. The RAPD patterns showed that ca 60% of E. coli recovered from the oral cavities and faeces during pasture and feedlot shared a close genetic relatedness. A number of E. coli with unique RAPD types were also found either in the oral cavities or faeces. Most of the E. coli RAPD types recovered from the oral cavities were shared among animals, but there were also RAPD types which were unique to individual animals. The E. coli populations of the oral cavities were genetically diverse and changed over time.

CONCLUSIONS

This study indicates that there are large numbers of E. coli carried in the oral cavities of beef cattle and those E. coli are closely related to strains found in the faeces. The oral cavities of cattle harbour a genetically diverse E. coli population.

SIGNIFICANCE AND IMPACT OF THE STUDY

The oral cavity may be an important reservoir of enteric pathogens which may transfer to meat during carcass dressing. A better understanding of the molecular ecology of E. coli in cattle would assist the design of approaches to control pathogenic strains during beef production and processing.

Genotypic analysis of Escherichia coli recovered from product and equipment at a beef-packing plant

AIMS

To identify sources of Escherichia coli on beef by characterizing strains of the organism on animals, equipment and product at beef-packing plant.

METHODS AND RESULTS

Generic E. coli were recovered from hides, carcasses, beef trimmings, conveyers and ground beef during the summer of 2001 (750 isolates) and winter of 2002 (500 isolates). The isolates were characterized by Random Amplification of Polymorphic DNA (RAPD). The numbers of E. coli recovered from dressed carcasses were less than the numbers recovered from hides. The numbers recovered from chilled carcasses were too few for meaningful analysis of the strains present on them but the numbers recovered from trimmings and ground beef were larger. The RAPD patterns showed that the majority of isolates from hides, carcasses, beef trimmings, conveyers and ground beef were of similar RAPD types, but a few unique RAPD types were recovered from only one of those sources. The E. coli populations present on the hides of incoming animals and in the beef-processing environment were highly diverse. Randomly selected E. coli isolates from each of the five sources were further characterized by pulsed-field gel electrophoresis (PFGE). Most genotypes of E. coli defined by PFGE corresponded to the E. coli types defined by RAPD.

CONCLUSIONS

The hides of the incoming animals appeared to be only one of the sources of the E. coli on trimmings and in ground beef, as additional sources were apparently present in equipment used for carcass breaking.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study indicates that hazardous microbiological contamination of meat may occur after the dressing of carcasses at commercial beef-packing plants, which suggests that attention should be given to the control of the contamination of meat during carcass breaking as well as during the dressing of carcasses.

Lipids and lipoprotein(a) concentrations in Pakistani patients with type 2 diabetes mellitus

AIM

The aim of the present study was to analyze serum lipoprotein(a) [Lp(a)] levels in Pakistani patients with type 2 diabetes mellitus (DM) and to find correlations between clinical characteristics and dyslipidaemias in these patients.

METHODS

Fasting blood samples were analyzed for Lp(a), total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), glucose and glycosylated haemoglobin (HbA1c) in 68 Pakistani patients with type 2 DM and 40 non-diabetic healthy control subjects.

RESULTS

Lp(a) levels were significantly raised in diabetics as compared to the control group. No correlation of Lp(a) was seen with age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP) and fasting glucose. There was a positive correlation of BMI to SBP and DBP. There was a significant positive correlation between Lp(a) and total cholesterol and LDL-c. No correlation of Lp(a) was observed with HDL-c, triglycerides and glycosylated haemoglobin (HbA1c).

CONCLUSION

The present study led us to conclude that serum Lp(a) levels are significantly raised in type 2 DM and have a positive correlation with serum total and LDL-c levels.

Second allogeneic bone marrow transplantation after myeloablative conditioning analysis of 43 cases from single institution

Between March 1984 and December 1999, a total of 43 second related allogeneic BMT procedures after myeloablative conditioning were carried out in our institution, 37 following allogeneic, and 6 following autologous BMT. Thirty one patients were males (72%). At 1st BMT (BMT1), median age was 11.5 years (range, 0.16-45 years). BMT1 was carried out for the diagnosis of AML in 13 patients (30%), SAA in nine (21%), ALL in six (14%), CML in six (14%), immunodeficiency in three (7%), NHL in two, beta-thal in two, HD in one, Red cell aplasia in one. HLA matching status for allogeneic BMT1 was full match in 33, one antigen mismatch in two and haplo identical in two patients. Median age at the 2nd BMT (BMT2) was 14 years (range, 0.41-46.7 years). Indications for BMT2 were recurrent hematologic neoplasm in 23 patients (53%), primary graft failure in 12 (28%) and late graft failure in 8 (19%). Median time from BMT1 to recurrence of hematologic neoplasm or late graft failure was 10 months (range, 2.5- 88 months). Median BMT1 to BMT2 interval was 13 months (range, 1-107 months). For BMT2, the same donor was used in 29 patients, while 14 patients had alternate related donor (12 full match, 1-one Ag mismatch, 1 haplo identical). A different conditioning regimen was used in the majority of the patients (39, 91%). Radiation containing conditioning regimen were used mostly for patients previously conditioned with chemotherapy only for BMT1 and chemotherapy conditioning +/- ATG for those who received radiation containing conditioning at BMT1. Bone marrow was the stem cell source for all patients at BMT2 and all except three autologous peripheral stem cell transplantation patient at BMT1. Significant organ toxicity leading to procedure related death in 13 patients (30%) was observed after BMT2. At a median follow up of 36 months after BMT2, 22 patients (51%) are alive (20 free of disease, 2 with recurrent disease) with overall median survival of 47.5 (SD +/- 9) months. Univariate analysis of relevant clinical factors identified the following variables as the only statistically significant favorable prognostic factors for overall survival: BMT1-BMT2 interval of > or = 6 months (P=0.0007) and age at BMT2 < or = 10 years (P=0.041). The nature of underlying disease (neoplastic or non-neoplastic) was not statistically significant (P=0.23). There was no statistically significant difference in survival outcome of BMT2 using same donor vs. alternate related donor (P=0.51). Due to the relatively limited sample size, multivariate analysis was not attempted. This single institution study suggests that second allogeneic BMT after myeloblative conditioning has an acceptable treatment related morbidity/mortality and favorable outcome if performed at age < or = 10 years and with an interval of > or = 6 months after the first BMT. Additionally same donor can successfully be used for the second transplant with similar survival outcome to alternate donor.

Kohl (surma): a toxic traditional eye cosmetic study in Saudi Arabia

The use of kohl (surma) as eyeliner is a popular practice in Saudi Arabia and people firmly believe that it is safe to use. A total of 107 kohl samples (branded and unbranded) were collected from different regions of Saudi Arabia, and analysed for the presence of lead. In addition, aluminium and antimony levels were also determined. Lead levels up to 53% were detected in some kohl preparations, and some samples were found to contain camphor and menthol. The blood analyses of regular kohl users revealed a high lead concentration and relatively low haemoglobin levels. Due to the health risk, an official public awareness campaign is suggested to encourage the use of lead-free kohl.

Promoter hypermethylation of MGMT, CDH1, RAR-beta and SYK tumour suppressor genes in granulosa cell tumours (GCTs) of ovarian origin

Ovarian carcinoma (OC) is a leading cause of death among women throughout the world. A number of cancer-associated genes have been shown to be inactivated by hypermethylation of CpG islands during tumorigenesis. We tested the hypothesis that methylation status of MGMT, CDH1, RAR-β and SYK could be important in the ovarian tumorigenic process and can lead to the gene(s) inactivation. Therefore, we assessed the promoter hypermethylation of MGMT, CDH1, RAR-β and SYK in 43 ovarian granulosa cell tumours (GCTs) (adult type) using methylation-specific PCR. These tumours are relatively rare, accounting for approximately 3% of all ovarian cancers. Hypermethylation of MGMT (in 14 tumours), CDH1 (in nine tumours), RAR-β (in eight tumours) and SYK (in seven tumours) have been found. Selective loss of RAR-β and RAR-β2 mRNA has been found in seven patients, while that of MGMT and SYK in three patients who also show aberrant methylation in promoter region of RAR-β in addition to MGMT, SYK and CDH1 genes. Promoter CpG hypermethylation may be an alternative to mutation(s) to inactivate tumour suppressor genes such as MGMT, CDH1, RAR-β and SYK, and this can also be an early event in the pathogenesis of OCs. Moreover, hypermethylation of the MGMT and CDH1, MGMT and RAR-β and CDH1 and RAR-β promoters occurred concordantly (P< 0.001, 0.0421 and 0.0005 respectively; Fischer's exact test). In addition to this, monosomy 22 and trisomy 14 have also been found in 10 tumours. It is clear from the results that hypermethylation of the promoter region of these tumour suppressor genes, monosomy 22 and trisomy 14, may be critical steps in the tumorigenesis, which consequently play a permissive role for tumour aggressiveness. All these events might play an important role in the early clinical diagnosis of the disease. Our results, therefore, suggest a potential role for epigenetic modification of these critical tumour suppressor genes in pathways relevant to the transformation and differentiation of rare type of ovarian cancer (GCTs).

Tumor embolization causing acute ischemia with sometimes fatal results. Case report and review of literature

Peripheral arterial embolism arising from a malignant tumor is an infrequent manifestation of neoplastic disease and also a rare cause of acute arterial occlusion. A diagnosis of lower limb acute ischemia in young adults could be overlooked because the condition is quite uncommon in this age group. A case of lower extremities arterial embolization from metastatic lung cancer of germ cell origin is reported and the literature is reviewed.

Atmospheric perfluorocarbons

Collectively, man-made emissions of a few greenhouse gases may cause about the same amount of global warming as increasing carbon dioxide. Among the most potent of these non-CO2 greenhouse gases are the perfluorocarbons that have extraordinarily long atmospheric lifetimes of 10,000 to more than 50,000 yr. We report atmospheric concentrations over two decades, between 1978 and 1997, of the three most abundant perfluorocarbons--CF4, C2F6, and C3F8--and delineate the sources that account for the present abundances and trends. We show that C2F6 and C3F8 are present at only 2.9 and 0.2 pptv, respectively. CF4 is the most abundant perfluorocarbon at 74 pptv (in 1997) of which about 40 pptv are from natural emissions, 33 pptv from aluminum manufacturing, and 1 pptv from the semiconductor industry. The increasing trend of CF4 has slowed in recent years due to the major reductions in the emission rate per ton of aluminum produced. The effect of the falling emission factor is partially offset by increased production and increasing use by the semiconductor industry.

Hypoxia and pulmonary acclimatisation at 4578 m altitude: the role of acetazolamide and dexamethasone

OBJECTIVES

To quantify the changes in ventilatory response and arterial blood gases in healthy male volunteers on acute ascent to 4578 meters altitude along with evaluating the role of acetazolamide and dexamethasone prophylaxis in acclimatisation.

METHODS

Forty four lowlander male subjects participated as two groups in the study. Twenty four lowlander healthy male adults (age mean +/- SE 27.8 +/- 1.24 years) comprised the non-acclimatised group. They were sub grouped in a double blind fashion into four. Each subgroup (n=6) received placebo (multivitamin) or acetazolamide (250 mg) or dexamethasone (4 mg) or combined regimen of the two drugs twice daily for 5 days commencing 24 hours before ascent. The volunteers reached the altitude of 4578 meters within a span of one day. The second group (acclimatised) comprised of age and height matched twenty volunteers who had arrived 4 and 8 weeks earlier at the same altitude. Arterial PO2, PCO2, SO2 and minute respiratory rate pH were measured. The pulmonary functions (FVC, %FEV1 PEF, FEF(25-75%) and MVV) were recorded by Compact Spirometer (Vitalograph). Pre and post ascent measurements were carried out in non-acclimatised group whereas one measurement of the same parameters were made in acclimatised group.

RESULTS

The study revealed a significant increase in respiratory rate min-1 after 24 hours of ascent along with reduction in PaO2 and SaO2. The gradual increase in PaO2 and SaO2 and reduction in PaCO2 was observed after 4 weeks at the same altitude. The reduction in FVC, %FEV1, PEF, FEF(25-75%) and MW were recorded in our subjects after 24 hours of acute ascent. Nevertheless, all pulmonary parameters in volunteers having 8 weeks of stay at 4578 m altitude, were found equivalent to the non-acclimatised group. The greater increase in minute respiratory rate, PaO2, SaO2 and pulmonary functions was found in volunteers taking acetazolamide.

CONCLUSION

It is concluded that hyperventilation and increase in lung volumes are the adaptive pulmonary responses which help in improving levels of PaO2 and SaO2. The acetazolamide-dexamethasone prophylaxis appears beneficial in promoting pulmonary acclimatisation during hypobaric hypoxia.

Modulation of oesophago-UOS contractile reflex: effect of proximal and distal esophageal distention and swallowing

Upper oesophageal sphincter (UOS) tone is influenced by intraoesophageal pressure events. Our aim was to test the hypothesis that UOS tone is responsive to simultaneous inhibitory and stimulatory signals originating from the oesophagus and compare effect of proximal and distal oesophageal air distention on oesophageal balloon-stimulated UOS contraction. We studied 16 healthy volunteers, ages 19-80 years in two stages. We induced UOS contraction by distending various size balloons intraoesophageally and studied response of contracted UOS to oesophageal air distentions and swallowing. Intraoesophageal injections of 60-ml room air resulted in UOS pressure augmentation (31%), relaxation (64%) and no effect in the remaining 5% of instances. The majority of air injections into the oesophageal segment proximal to the distended balloon were followed by relaxation of the contracted UOS, whereas, the majority of oesophageal air distentions distal to the balloon resulted in augmentation of UOS contraction (P < 0.01). Swallowing resulted in complete relaxation of the UOS. In conclusion, UOS contractile response to oesophageal balloon distention is overridden by further augmentation or relaxation as a result of oesophageal air distention and swallowing. Contractile and inhibitory responses of the contracted UOS to generalized oesophageal distention is region-specific.

Lipoprotein (a) and glycaemic control in Pakistani subjects with diabetes mellitus

AIMS

To measure lipoprotein (Lp)(a) levels in people with diabetes mellitus (DM) and to see if there is any difference in Lp(a) levels between diabetics with good glycaemic control and those with poor glycaemic control.

METHODS

Sixty subjects with DM and thirty healthy individuals were studied. Fasting blood samples were analyzed for glucose, glycosylated hemoglobin, Serum total cholesterol, triglycerides, low density lipoproteins, high density lipoproteins and Lp(a).

RESULTS

A non significant difference was found between the lipid profile of normal individuals and subjects with DM with a good glycemic control. Lp(a) levels were significantly raised in diabetics. The difference in Lp(a) levels between well controlled and poorly controlled diabetics was non significant. In the control group 23.4% of individuals had high risk levels of Lp(a) while it was 46.7 % for people with DM.

CONCLUSION

Glycaemic control improves lipid profile positively in diabetics and may even lead to near normalization of lipoprotein concentrations. Diabetics have elevated levels of Lp(a) and the difference in Lp(a) levels between well controlled and poorly controlled diabeticsts is non-significant.

Reliability of pre-operative biopsies in the histological grading of colorectal adenocarcinomas

BACKGROUND

Management of colorectal cancer depends on many patient and tumour variables. Decisions are sometimes based on the histological grade of tumour as assessed by initial biopsy. This retrospective study looked at the reliability of grading colorectal cancer from pre-operative biopsies.

METHODS

118 patients with a diagnosis of colorectal cancer, who had adequate pre-operative biopsies, were included in the study. A single consultant histopathologist re-examined all the preoperative biopsy slides, but was blinded to the final grading of the resection specimen.

RESULTS

Of the 118 resection specimens, 41 were graded well-differentiated, 52 moderately differentiated and 25 poorly differentiated. When compared with postoperative grading, 37 (31%) initial biopsies were undergraded, 49 (43%) were correctly graded and 32 (26%) were overgraded.

CONCLUSIONS

These results suggest that the histological grading of pre-operative specimens is inaccurate and should be used with caution to determine treatment. The difficulty with grading pre-operative biopsies in colorectal cancer may be owing to a lack of specific criteria such as is used in, for example, breast cancer.

Solution structures of complement components by X-ray and neutron scattering and analytical ultracentrifugation

The short consensus/complement repeat (SCR) domain (also known as the complement control protein domain) is the most abundant domain type in the complement system. Crystal and NMR structures for proteins that contain single and multiple SCR domains have now been published. These contain inter-SCR linkers of between three and eight residues, and the structures show much variability in inter-SCR orientations. X-ray and neutron scattering, combined with analytical ultracentrifugation and constrained modelling based on known subunit structures will yield a medium-resolution structure for the protein of interest. The fewer parameters that are associated with the structure of interest, the more defined the structure of interest becomes. These solution studies have been applied to several SCR-containing proteins in the complement system, most notably Factor H with 20 SCR domains, a complement receptor type 2 fragment with two SCR domains, and rat complement receptor-related protein (Crry) which contains five SCR domains. The results show great conformational variability in the inter-SCR orientation, and these will be reviewed. Even though the rotational orientation cannot be modelled, it is nonetheless possible to measure the degree of extension of the multi-SCR proteins and, from this, to obtain functionally useful results.

Pictorial review: MRI of the sternum and sternoclavicular joints

The sternum and sternoclavicular joints are difficult to evaluate with plain radiographs. The value of CT in assessing lesions of the sternum and sternoclavicular joints has been well documented, but the potential role of MRI has not been emphasized. We present the MRI techniques, normal appearances and a spectrum of abnormalities, and emphasize the role of MRI as a useful radiological investigation for the sternum and sternoclavicular joints.

An unusual complication of penile prosthesis following urethroplasty

We report a case of an adult who had undergone transpubic urethroplasty for a 5-cm long posterior urethral stricture. A malleable penile prosthesis (AMS 600R) was implanted 19 months later for the trauma-related impotence. The patient was discovered to develop a complete obliteration of the urethra after removal of infected penile prosthesis 18 months later. Perineal urethroplasty cured his restricture. Suggestions are made to prevent urethral restricture if penile prosthesis is required after urethroplasty.