Bacterial pretreatment enhances removal of heavy metals during treatment of post-methanated distillery effluent by Typha angustata L

A combination of bacterial pretreatment followed by free water surface flow through wetland plants was investigated to determine its effect on removal of heavy metals in bioremediation of post-methanated distillery effluent (PMDE). The bacterial pretreatment was intended to transform the metal complexes and organic pollutants into simpler, biologically assimilable molecules. The 10% and 30% v/v concentrations of PMDE favored luxuriant bacterial growth; the 50% concentration supported less growth, whereas the undiluted effluent (i.e., 100%) supported very little bacterial growth. The use of bacterial pretreatment combined with the constructed wetland system greatly increase the overall bioaccumulation of all heavy metals by the plants compared with the control treatment. However, the integration of bacterial pretreatment of PMDE with the Typha angustata resulted in enhanced removal of Cd (34.02-61.50% increase), Cr (35.90-57.60% increase), Cu (32.88-54.22% increase), Fe (32.50-51.26% increase), Mn (35.99-82.85% increase), Ni (35.85-59.24% increase), Pb (33.45-59.51% increase) and Zn (31.95-53.70% increase) compared with a control that lacked this pretreatment. In addition to the bioaccumulation of these heavy metals, several physico-chemical parameters also improved at the 30% effluent concentration: color, BOD, COD, phenol and total nitrogen decreased by 98.33%, 98.89%, 98.50%, 93.75% and 82.39%, respectively, after 7 days of free water surface flow treatment. The results suggest that bacterial pretreatment of PMDE, integrated with phytoremediation will improve the treatment process of PMDE and promote safer disposal of this waste.

High prevalence of type 2 diabetes mellitus in affluent urban Indians

The highest prevalence of type 2 diabetes mellitus in developing countries occurs in the upper socio-economic group, but this has not been well documented in Indians. The age and sex standardized prevalence of diabetes in 1112 affluent adult Indian subjects was 21.1%. This is the highest prevalence of diabetes reported from India.

Human milk fortification and gastric emptying in the preterm neonate

Fortification of expressed breast milk (EBM) is widely recommended for preterm feeding. Fortification of EBM results in increased caloric density and osmolarity, both of which may retard gastric emptying. As gastric emptying is a major determinant of feed tolerance, we investigated the effect of fortification (with Lactodex HMF) of EBM on gastric emptying in preterm neonates. The half gastric emptying time was measured using real time ultrasonography in 25 consecutive preterm neonates first on EBM alone, then on EBM + Lactodex HMF. Each baby served as its own control. The students t-test was used for statistical analysis. The mean gestation age was 34.48 +/- 0.77 weeks. The mean birth weight was 1.92 +/- 0.14 kg. The mean half gastric emptying time at an age of 5.4 +/- 0.86 days on EBM was 24.00 +/- 5.00 min and 24.40 +/- 5.06 min on EBM + human milk fortifier (HMF). The same at 2nd assessment (15.2 +/- 1.79 days), with EBM was 22.80 +/- 4.58 min vs. 23.60 +/- 4.89 min when given EBM + HMF. These differences were not statistically significant. Fortification of EBM with Lactodex HMF does not affect the gastric emptying in preterm neonates and therefore is unlikely to affect feed tolerance in them.

Effects of cross-link breakers, glycation inhibitors and insulin sensitisers on HDL function and the non-enzymatic glycation of apolipoprotein A-I

AIMS/HYPOTHESIS

Hyperglycaemia, a key feature of diabetes, is associated with non-enzymatic glycation of plasma proteins. We have shown previously that the reactive alpha-oxoaldehyde, methylglyoxal, non-enzymatically glycates apolipoprotein (Apo)A-I, the main apolipoprotein of HDL, and prevents it from activating lecithin:cholesterol acyltransferase (LCAT), the enzyme that generates almost all of the cholesteryl esters in plasma. This study investigates whether the glycation inhibitors aminoguanidine and pyridoxamine, the insulin sensitiser metformin and the cross-link breaker alagebrium can inhibit and/or reverse the methylglyoxal-mediated glycation of ApoA-I and whether these changes can preserve or restore the ability of ApoA-I to activate LCAT.

METHODS

Inhibition of ApoA-I glycation was assessed by incubating aminoguanidine, pyridoxamine, metformin and alagebrium with mixtures of methylglyoxal and discoidal reconstituted HDL (rHDL) containing phosphatidylcholine and ApoA-I, ([A-I]rHDL). Glycation was assessed as the modification of ApoA-I arginine, lysine and tryptophan residues, and by the extent of ApoA-I cross-linking. The reversal of ApoA-I glycation was investigated by pre-incubating discoidal (A-I)rHDL with methylglyoxal, then incubating the modified rHDL with aminoguanidine, pyridoxamine or alagebrium.

RESULTS

Aminoguanidine, pyridoxamine, metformin and alagebrium all decreased the methylglyoxal-mediated glycation of the ApoA-I in discoidal rHDL and conserved the ability of the particles to act as substrates for LCAT. However, neither aminoguanidine, pyridoxamine nor alagebrium could reverse the glycation of ApoA-I or restore its ability to activate LCAT.

CONCLUSIONS/INTERPRETATION

Glycation inhibitors, insulin sensitisers and cross-link breakers are important for preserving normal HDL function in diabetes.

Chemical composition and larvicidal activities of the essential oil of Zanthoxylum armatum DC (Rutaceae) against three mosquito vectors

BACKGROUND & OBJECTIVES

In view of the recently increased interest in developing plant origin insecticides as an alternative to chemical insecticide, this study was undertaken to assess the larvicidal potential of the essential oil from the seeds of Zanthoxylum armatum DC [syn. Z. alatum Roxb] (Rutaceae) against three medically important species of mosquito vectors, Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus.

METHODS

Essential oil was hydro distilled in the laboratory from the seeds obtained from the market and the chemical constituents of the oil were determined using GC/GC-MS. Bioefficacy of the essential oil was evaluated under laboratory conditions using III instar mosquito larvae.

RESULTS

Among the three mosquito species tested, Cx. quinquefasciatus was the most sensitive (LC50 = 49 ppm) followed by Ae. aegypti (LC50 = 54 ppm) and An. stephensi (LC50 = 58 ppm). GC-MS analysis of the oil revealed at least 28 compounds, consisting mainly of oxygenated monoterpenes (75%) and monoterpenes (22%). Linalool though constituted a major part (57%), failed to produce any appreciable mortality when tested alone.

INTERPRETATION & CONCLUSION

From the results it can be concluded that the larvae of the three mosquito species were susceptible to the essential oil composition. Such findings would be useful in promoting research aiming at the development of new agent for mosquito control based on bioactive chemical compounds from indigenous plant sources as an alternative to chemical larvicides.

Mini-implants for retraction, intrusion and protraction in a Class II division 1 patient

This case report demonstrates the clinical utility and versatility of mini-implants in carrying out different types of tooth movement in a 14-year-old boy with a 'severe' Class II division 1 malocclusion. Mini-implants were placed for 'en masse' retraction and intrusion of maxillary anterior teeth and for lower molar protraction. More than 11 mm of maxillary incisor retraction was achieved together with 3 mm of intrusion. There was significant reduction in the dentoalveolar protrusion and retraction of the upper lip, which resulted in decreased mentalis strain and improved chin projection. Cephalometric superimposition and panoramic radiographs showed no anchorage loss and good occlusion at the end of treatment.

Impact of timing of initiation of adjuvant chemotherapy on survival after resection of colorectal cancer

4054

Background: Based on the results of intergroup trials, adjuvant chemotherapy has become the standard of care for patients with Duke stage C colon and Duke stages B and C rectal cancer. Although initiation of adjuvant chemotherapy soon after recovery from surgery is desirable, only few studies have examined whether a delay in starting adjuvant chemotherapy affect clinical outcomes. Our objective in this study is to determine the impact of timing of adjuvant chemotherapy on survival after resection of Duke stage C colon and Duke stages B and C rectal cancer. Methods: Study involves use of the information available from patients chart review in the province of Saskatchewan, Canada. Patients 18 years of age and older (median age 66 years), diagnosed with Duke Stage C colon and Duke stages B and C rectal cancer between 1993 and 2000 were included. Median followup was 54.8 months. All patients with rectal cancer received radiation treatment as per institution policy. Cox proportional hazards models were used to analyze the impact of timing of adjuvant chemotherapy on survival. Results: Among 701 patients eligible for study, 453 (64.6%) patients received adjuvant chemotherapy within 56 days of surgery (group I) and 248 patients (35.3 %) received adjuvant chemotherapy after 56 days of surgery (group II). Median time interval between surgery and the initiation of adjuvant chemotherapy in group I, and II were 41 days and 70 days respectively. Five year DFS for group I was 39% as compared to 37% for group II (HR 0.94, CI 0.76–1.16, p = 0.58). Median OS for group I was 97.5 months as compared to 68.9 months (HR 1.08, CI 0.85–1.37, p= 0.54). Age, histology and number of lymph nodes analyzed, were identified as independent prognostic factors in multivariate analysis. Conclusions: In this study, patients with Duke stage C colon and Duke stages B and C rectal cancer who received adjuvant chemotherapy within 56 days of resection has similar outcomes as compared to patients who received adjuvant chemotherapy after 56 days of resection.

[Table: see text]

Prognostic importance of primary tumor resection in patients with advanced colorectal cancer (CRC): A Canadian province’s experience

14529

Background: Surgical resection (SR) of primary tumor in patients with newly diagnosed advanced CRC remains controversial. Limited data is available regarding potential benefit of resection in these patients. We performed a population-based study to determine the prognostic value of SR of primary tumor in patients with metastatic CRC. Methods: Medical records of patients with metastatic CRC diagnosed between 1991–2000 in the province of Saskatchewan were reviewed. Patients with unresectable T4M0 disease were excluded. A multivariate analysis was performed using Cox regression model and various clinicopathologic variables were tested for their prognostic significance. Kaplan-Meier curves were used to determine survival. A preliminary analysis of data of 212 eligible patients diagnosed between 1998–2000 is presented here. Results: Patients median age was 71 yrs (33–94) and M:F was 1:0.77. One hundrad thirty one (62%) patients underwent SR for the primary tumor. Among 131 patients, 76 (58%) were operated for tumor related symptoms (36% obstruction, 14% perforation, and 9% bleeding). Six percent patients died of postoperative complications. Of 212 patients, 36% received 5FU-based chemotherapy (46% patients with SR) and 17% received a second line therapy. Median overall survival (OS) of all patients was 6.7 months. Patients who underwent SR of primary tumor had a significantly better median OS of 11 months compared with 3 months in patients who did not have surgery (HR 0.47; 95% CI 0.29–0.76). Patients who underwent SR and had received chemotherapy had a median OS of 14.8 months compared with median OS of 6 months if they did not receive chemotherapy (HR, 0.29; 95% CI 0.15–0.55). In addition to 5FU-based chemotherapy and SR of primary tumor; metastectomy, age >65 yrs, elevated alkaline phosphatase level and thrombocytosis were other important variables that were correlated with survival in patients with advanced CRC. Conclusions: SR of primary tumor has been associated with significant improvement in survival independent of systemic chemotherapy in patients with advanced CRC. Further analysis of data in patients diagnosed between 1991–2000 is planned to confirm these findings in a larger group of patients.

No significant financial relationships to disclose.

Isolation and Characterization of an Indian Orf Virus from Goats

Isolation and characterization of an orf virus has been described here. The virus was isolated from an outbreak of 'scabby mouth' in goats in Northern India. Viral morphology from the scab biopsy revealed typical ovoid-shaped particles characteristic of Parapoxvirus. Virus was isolated from sonicated scab suspension and characterized by restriction enzyme (RE) analysis and sequencing of full-length GM-CSF- and interleukin-2 inhibitory factor (GIF) gene. RE pattern of the virus did not show close resemblance to most of the orf viruses published earlier. However, it showed high sequence identity and closer phylogenetic relationship with previously published ORFV-SA00 strain, as evident from the nucleotide and deduced amino acid sequence of GIF gene.

Insulin therapy

Optimal glycemic control in type 1 diabetes mellitus (T1DM) requires Intensive Insulin Therapy. Implementation of intensive therapy should be early and prolonged as suggested by the results of Diabetes control and complications trial and Epidemiology of Diabetes Interventions and Complications (EDIC) study. Proper implementation of intensive therapy requires a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment as shown by the Dose adjustment for normal eating (DAFNE) randomized controlled trial. Pen injectors appear to be feasible for routine use although pumps may be required in special situations. Various types of insulin are available in the market, including newer analogs (Iispro, aspart, glargine). Although insulin analogs seem to be more physiological, controlled studies suggested either similar efficacy to regular insulin or only a minor benefit in favor of insulin analogs. The primary concern in developing countries like India is the cost-benefit ratio of short acting insulin analogs in the treatment of diabetic children but this still remains unclear. It would be premature to recommend switching patients to newer analogs especially those who are well controlled, especially when the long-term data is still awaited. The choice of post-meal short acting insulin in toddlers may be decided by the care provider if deemed appropriate. Noninvasive insulin deliveries are now in development. It does appear that the most clinically viable non-invasive system to date may be pulmonary delivery.

Oral squamous cell carcinoma: etiology, pathogenesis and prognostic value of genomic alterations

Tumours of the head and neck comprise an important group of neoplasia, the incidence of which is increasing in many parts of the world. This increase remains high, despite all the advances in modern medicine. This malignancy is more prevalent in the developing world and unfortunately, has not received satisfactory attention as the more prevalent cancers of the developed world, like lung, breast, or colon cancer. Recent advances in diagnosis and therapeutic techniques of these lesions have yielded novel molecular targets, uncovered signal pathway dominance and advanced early cancer detection. This review covers recent advances in our understanding of the etiology, molecular changes and the possible role that genomic and proteomic research might play in the diagnosis and effective cure of this modern-day scourge.

Discordence of HER-2/neu overexpression and estrogen receptor between the primary breast cancer and axillary lymph node with metastasis

20106

Background: Adjuvant hormonal therapy and trastuzumab are known to be associated with a significant reduction in cancer-related mortality in a subset of women with breast cancer. The treatment decision is usually based on immunohistochemistry (IHC) staining of the primary tumor. We reported here a case of discordance of HER-2/neu overexpression and estrogen receptor status between the primary breast cancer and axillary lymph node with metastasis. Methods: IHC and fluorescence in situ hybridization (FISH) analysis was perfromed for the assessment of HER-2/neu. E-cadherin staining was done on the primary tumor and lymph node with metastasis. Results: A 52 year old woman presented with right breast lump. The imaging studies showed a 5 × 5 cm speculated mass. No other abnormalities were noted. An excision biopsy revealed 3 cm moderately differentiated invasive lobular carcinoma. Subsequently a wider excision and axillary lymph node dissection was done. 2/20 lymph nodes were involved by the cancer. IHC was done in the primary tumor and the lymph node with metastasis. IHC of the primary tumor revealed less than 1% nuclei positive for estrogen receptor (ER), 0% nuclei positive for progesterone receptor (PR), and no HER-2/neu overexpression. IHC of the lymph nodes with metastasis revealed 80% nuclei positive for ER, less than 1% nuclei positive for PR, and equivocal HER-2/neu overexpression. FISH analysis for HER-2/neu gene was done on the primary tumor which revealed no amplification in the tumor nuclei (Her2/CEP17 ratio was 3.6/2.7 = 1.3) whereas FISH analysis on the lymph node section revealed amplification in tumor nuclei (Her2/CEP 17 ratio of 7.3/1.9 = 3.9). E-cadherin staining of the primary breast tumor as well as the lymph node with metastasis revealed no membrane staining of the malignant cells in either section. Conclusions: The unusual occurrence of a divergent IHC profile and FISH analysis results between the primary carcinoma and metastatic carcinoma may be due to a subselection of a malignant clone which were not represented in the section of primary tumor chosen for IHC. Future studies are required to determine the utility of IHC staining of metastatic cells involving the lymph nodes if primary tumor is negative for HER-2/neu & ER.

No significant financial relationships to disclose.

Gemcitabine-related thrombocytosis: Does it increase the risk of thrombosis?

6091

Background: Gemcitabine is an antimetabolite agent that has demonstrated activity in various solid and hematological malignancies. Although thrombocytopenia is a known side effect, gemcitabine-related thrombocytosis has been uncommonly reported. Chemotherapy increases the risk of thrombo-embolism in patients with cancer. The study aimed to identify the incidence of gemcitabine-related thrombocytosis and to determine whether it has been associated with an increased risk of thrombo-embolism. Methods: Medical records of 175 consecutive adults patients with a malignant disease who received gemcitabine at Saskatoon Cancer Center were reviewed. Patients with history of prior thrombo-embolism or with baseline thrombocytosis were excluded. Fisher’s Exact test was done for statistical analysis. Results: 149 eligible patients with median age of 62 (26–83) and M:F of 1.01:1 were identified. 141 (95%) patients had advanced malignancy and 61 (41%) had received prior chemotherapy. 106 (71%) patients received combination of chemotherapy and 95% of those patients received gemcitabine in combination with a platinum compound. Median number of cycle was 3 (1–8). Median platelets count prior to commencement of gemcitabine was 285 × 109 (44–449). 83 (56%) patients experienced thrombocytopenia whereas 69 (46%) patients experienced thrombocytosis within 3 weeks of treatment with gemcitabine. Median post-gemcitabine platelet count in patients with thrombocytosis was 622 × 109 (457–1385). 15 (10%) patients experienced thrombocytosis with each cycle of gemcitabine. Median duration of thrombocytosis was 2 weeks (0.5−5). 13 (9%) of 149 patients experienced a vascular event (venous, n=9; arterial, n=4) within 6 weeks of treatment with gemcitabine. Median platelet count prior to the vascular event was 268 × 109 (79–669). All except one patient had advanced malignancy and 85% had received combination of chemotherapy. 5 of 69 (7%) patients with thrombocytosis experienced a vascular event compared with 8 of 80 (10%) patients without thrombocytosis (p=0.77). Conclusions: Gemcitabine has been associated with an increased incidence of thrombocytosis. However gemcitabine-related thrombocytosis is a transient phenomenon and has not been associated with an increased risk of a vascular event.

No significant financial relationships to disclose.

Forced Uptake of Trivalent and Pentavalent Methylated and Inorganic Arsenic and Its Cyto-/genotoxicity in Fibroblasts and Hepatoma Cells

Mammals are able to convert inorganic arsenic to mono-, di-, and trimethylated metabolites. In previous studies we have shown that the trivalent organoarsenic compounds are more toxic than their inorganic counterparts and that the toxicity is associated with the cellular uptake of the arsenicals. In the present study, we investigated cyto-/genotoxic effects of the arsenic compounds arsenate [As(i)(V)], arsenite [As(i)(III)], monomethylarsonic acid [MMA(V)], monomethylarsonous acid [MMA(III)], dimethylarsinic acid [DMA(V)], dimethylarsinous acid [DMA(III)], and trimethylarsine oxide [TMAO(V)] after an extended exposure time (24 h) and compared the uptake capabilities of fibroblasts (CHO-9 cells: Chinese hamster ovary) used for genotoxicity studies, with those of hepatic cells (Hep G2: hepatoma cell-line). To find out whether the arsenic compounds are bound to membranes or if they are present in the cytosol, the amount of arsenic was measured in whole-cell extracts and in membrane-removed cell extracts by inductively coupled plasma-mass spectrometry (ICP-MS). In addition, we forced the cellular uptake of the arsenic compounds into CHO-9 cells by electroporation and measured the intracellular arsenic concentrations before and after this procedure. Our results show that organic and inorganic arsenicals are taken up to a higher degree by fibroblasts compared to hepatoma cells. The arsenic metabolite DMA(III) was the most membrane permeable species in both cell lines and induced strong genotoxic effects in CHO-9 cells after an exposure time of 24 h. The uptake of all other arsenic species was relatively low (<1% by Hep G2 and <4% by CHO cells), but was dose-dependent. Electroporation increased the intracellular arsenic levels as well as the number of induced MN in CHO-9 cells. With the exception of As(i)(III) and DMA(III) in CHO-9 cells, the tested arsenic compounds were not bound to cell membranes, but were present in the cytosol. This may indicate the existence of DMA(III)-specific exporter proteins as are known for As(i)(III). Our results indicate that the uptake capabilities of arsenic compounds are highly dependent upon the cell type. It may be hypothesized that the arsenic-induced genotoxic effects observed in fibroblasts are due to the high uptake of arsenicals into this cell type. This may explain the high susceptibility of skin fibroblasts to arsenic exposure.

Effect of lindane on hepatic and brain cytochrome P450s and influence of P450 modulation in lindane induced neurotoxicity

Oral administration of lindane (2.5, 5, 10 and 15 mg/kg, body weight) for 5 days was found to produce a dose-dependent increase in the activity of P450 dependent 7-ethoxyresorufin-O-deethylase (EROD), 7-pentoxyresorufin-O-dealkylase (PROD) and N-nitrosodimethylamine demethylase (NDMA-d) in rat brain and liver. A significant increase in the hepatic and brain P450 monooxygenases was also observed when the duration of exposure of low dose (2.5 mg/kg) of lindane was increased from 5 days to 15 or 21 days. As observed with different doses, the magnitude of induction in the activity of P450 monooxygenases was several fold higher in liver microsomes when compared with the brain. Western blotting studies have indicated that the increase in the P450 enzymes could be due to the increase in the expression of P450 1A1/1A2, 2B1/2B2 and 2E1 isoenzymes. In vitro studies using organic inhibitors specific for individual P450 isoenzymes and antibody inhibition experiments have further demonstrated that the increase in the activity of PROD, EROD and NDMA-d are due to the increase in the levels of P450 2B1/2B2, 1A1/1A2 and 2E1 isoenzymes, respectively. Induction studies have further shown that while pretreatment of 3-methylcholanthrene (MC), an inducer of P4501A1/1A2, did not produce any significant effect in the incidence of lindane induced convulsions, pretreatment with phenobarbital (PB), an inducer of P450 2B1/2B2 or ethanol, an inducer of P450 2E1 catalysed reactions, significantly increased the incidence of lindane induced convulsions. Similarly, when the P450-mediated metabolism of lindane was blocked by cobalt chloride incidence of convulsions was increased in animals treated with lindane indicating that lindane per se or its metabolites formed by PB or ethanol inducible P450 isoenzymes are involved in its neurobehavioral toxicity.

Cyclo-oxygenase 2 inhibitors: emerging roles in the gut

BACKGROUND AND AIMS

Discovery of an isoform of Cyclo-oxygenase (COX) 1, the inducible COX-2, has made it possible to avoid some side effects of non-specific COX inhibitors. The COX-2 gene is over-expressed in reflux oesophagitis, Barrett's oesophagus, gastric and colon cancer, familial adenomatous polyposis, pancreatic cancer, hepatocellular carcinoma, hepatotoxicity, cirrhosis, and inflammatory bowel disease, and specific COX-2 inhibitors have been tried experimentally and clinically and found effective.

METHODS

A Medline search was performed of English-language experimental studies and controlled clinical trials from January 1980 to January 2002, and relevant citations were noted.

RESULTS

Review of available literature shows that sulindac and COX-2 inhibitors are effective in preventing as well as regressing familial adenomatous polyposis. However, they have not been shown to prevent cancer in these patients. Studies evaluating NSAIDs and COX-2 inhibitors in carcinogen-induced and genetically manipulated animal models of various cancers have been promising especially in conditions such as Barrett's oesophagus, oesophageal and hepatocellular carcinoma and pancreatic cancer. COX-2 inhibitors may be of value in the treatment of reflux oesophagitis, pancreatitis and hepatitis, although carefully planned randomized controlled clinical trials demonstrating their efficacy need to be conducted. At present NSAIDs and COX-2 inhibitors cannot be recommended for average-risk individuals or for those with sporadic colorectal neoplasia (or other forms of cancers) as chemo-preventive agents.

CONCLUSION

COX-2 inhibitors may open up a new therapeutic era in which these drugs can be used for chemo-prophylaxis. However, COX-2 selective inhibitors retain renal adverse effects of the non-selective inhibitors and the concern regarding the pro-thrombotic potential of COX-2 inhibitors will limit their value as chemo-preventive agents.

An age- and sex-controlled matched pair analysis of T scores in ethnic Indians with hip fractures

OBJECTIVE

The first study to predict peritrochanteric fractures by the use of T scores amongst the Indian population was performed. This study aimed to assess the risk of fracture around the hip in peri-menopausal and postmenopausal women, and in men over the age of 35 years using dual energy X-ray absorptiometry, and to analyse whether the result, i.e. the T score, can predict an impending hip fracture.

METHODS

T scores of the unaffected hip in 30 patients with peritrochanteric fractures were determined, and matched pair analysis was done using a control group without fracture. All patients were from a single centre and were evaluated using the same scanner.

RESULTS

The mean T score of the 30 patients in the fracture group was -3.34 (range, -1.2 to -5.1; standard deviation [SD], 1.032), compared with the mean T score of the 30 control subjects which was -2.41 (range, 0.6 to -5.0; SD, 1.378). T scores of patients from the fracture group were significantly lower than those in the control group.

CONCLUSION

We infer that T scores are the best predictors for fracture risk. A score of -2.5 or lower effectively defines patients at risk and is useful for predicting fracture risk in the Indian population. In patients with osteoporosis, whether a fall precedes the fracture or the fracture precedes a fall may not be an issue of debate, but can serve as a basis for prevention of additional fractures by instituting appropriate measures in patients at risk.

Identification and characterization of murine Brunol4, a new member of the elav/bruno family

RNA-binding proteins are involved in post-transcriptional processes like mRNA stabilization, post-transcriptional modification, and transport and have been suggested to play an important role in developmental gene regulation. We report here the cloning and characterization of Brunol4, a novel mouse cDNA closely related to the elav-type family of genes encoding for RNA-binding proteins and a subfamily recently named after the bruno gene of Drosophila. Murine Brunol4 is localized near the centromere of chromosome 18. The cDNA sequence of Brunol4 is separated by 12 introns and the size of Brunol4 may be around 250 kb due to the large size of several introns. Brunol4 expression is detectable in the developing embryo and, later on becomes mainly restricted to cerebral structures, in particular the cerebellum where it persists in the adult organism. We predict a role of Brunol4 and the respective human homologue in differentiation and maintenance of neuronal structures.

Hypoglycemic and antihyperglycemic activity of Murraya koenigii leaves in diabetic rats

The commonly used spice curry patta (Murraya koenigii) is traditionally consumed by diabetics in southern part of India. Feeding of diet containing various doses of curry leaves (5, 10 and 15%) to normal rats for 7 days as well as mild diabetic (blood glucose levels >175 mg/dl induced by alloxan 35 mg/kg IP) and moderate diabetic rats (blood glucose levels >250 mg/dl induced by STZ 60 mg/kg IP) for 5 weeks showed varying hypoglycemic and anti-hyperglycemic effect. In normal rats, reduction in blood glucose was almost negligible (approximately 4% with 10 and 15% diet). In mild and moderate diabetic rats, feeding of 5, 10 and 15% diet caused a maximal reduction in blood sugar by 13.1, 16.3 and 21.4% (NS, P<0.05 and 0.005) and 3.2, 5.58, 8.21% (NS), respectively. The mechanism of action is further discussed in light of results of previous and the present study.

Infantile Alexander disease: a GFAP mutation in monozygotic twins and novel mutations in two other patients

Alexander disease (AD) is a rare disorder of cerebral white matter due to a dysfunction of astrocytes. The most common infantile form presents as a megalencephalic leukodystrophy. Recently, heterozygous de novo mutations in the glial fibrillary acidic protein gene (GFAP) have been demonstrated to be associated with AD. We report heterozygous mutations in GFAP in 5 patients, including a pair of monozygotic twins, with clinical and neuroradiological features of infantile AD. Novel mutations were detected affecting nucleotides 304 T --> C (L97 P) and 730 G --> C (R239 P) in two other patients. None of the parents of our patients carried the mutations stressing dominant de novo mutations as the cause of AD. The presence of an identical mutation 250 G --> A (R79 H) in both monozygotic twins with infantile AD points to the origin of these GFAP mutations in germ cells or very early postzygotic stages.

Medicinal plants of India with anti-diabetic potential

Since ancient times, plants have been an exemplary source of medicine. Ayurveda and other Indian literature mention the use of plants in treatment of various human ailments. India has about 45000 plant species and among them, several thousands have been claimed to possess medicinal properties. Research conducted in last few decades on plants mentioned in ancient literature or used traditionally for diabetes have shown anti-diabetic property. The present paper reviews 45 such plants and their products (active, natural principles and crude extracts) that have been mentioned/used in the Indian traditional system of medicine and have shown experimental or clinical anti-diabetic activity. Indian plants which are most effective and the most commonly studied in relation to diabetes and their complications are: Allium cepa, Allium sativum, Aloe vera, Cajanus cajan, Coccinia indica, Caesalpinia bonducella, Ficus bengalenesis, Gymnema sylvestre, Momordica charantia, Ocimum sanctum, Pterocarpus marsupium, Swertia chirayita, Syzigium cumini, Tinospora cordifolia and Trigonella foenum graecum. Among these we have evaluated M. charantia, Eugenia jambolana, Mucuna pruriens, T. cordifolia, T. foenum graecum, O. sanctum, P. marsupium, Murraya koeingii and Brassica juncea. All plants have shown varying degree of hypoglycemic and anti-hyperglycemic activity.

Purification, crystallization and preliminary X-ray diffraction studies of disintegrin (schistatin) from saw-scaled viper (Echis carinatus)

This is the first report of crystallographic data on a disintegrin molecule from any source. The heterodimeric disintegrin with a molecular weight of 14 kDa from Echis carinatus venom is a potent antagonist of alpha4 integrins. The intact disintegrin, containing two subunits A and B, was isolated and purified using affinity and ion-exchange columns. It has been crystallized using 1.6 M ammonium sulfate as a precipitating agent. The crystals grew to dimensions of 0.25 x 0.20 x 0.20 mm and diffracted to 2.5 A resolution. The crystals belong to space group I4(1)22, with unit-cell parameters a = b = 91.7, c = 55.1 A. Assuming a molecular weight of 14 kDa, a V(M) of 2.1 A(3) Da(-1) is obtained for one molecule of disintegrin in the asymmetric unit.

Comparison of two blood collection techniques for measles antibody detection in children

BACKGROUND & OBJECTIVES

Though several seroprevalence and seroconversion studies have been conducted for measles using the filter paper haemagglutination inhibition (FPHAI), very few studies have compared the conventional serum HAI with the FPHAI. The present study was aimed at the evaluation of whole blood samples on filter paper as an alternative to serum specimens for detection of antibodies to measles virus.

METHODS

Serum and whole blood samples soaked on filter paper were collected from 165 randomly selected healthy children in the age groups of 1-2 yr. HAI test was performed on both sets of samples and the results compared.

RESULTS

Ninety samples that gave a titre of 8 or more by serum HAI also had titres of > or = 8 by FPHAI showing 100 per cent agreement between the two assays. Seventeen samples that had a serum HAI titre of 2 and 4 were missed by FPHAI due to the starting dilution of 8 of the latter. However, FPHAI gave no false positive results compared with serum HAI.

INTERPRETATION & CONCLUSION

Collection of the FP samples by finger prick is more acceptable and requires less expertise than venepuncture. Thus, in spite of the small percentage of missed cases by the filter paper method, this technique of sampling was found to be a convenient and reliable alternative to venepuncture, for detection of measles virus antibody especially in large scale seroepidemiological studies.

Anthelmintics: a review

Helminths infect 25% of the world's population. In the last 50 years specific, safe and effective anthelminitic drug therapy for various parasitic infestations have been developed. The population of the developing countries across the globe suffers not only as a direct result of these infections but due also to co-morbidity such as anemia, malnutrition and reduced immunity status. Earlier anthelmintic drugs suffered from serious drawbacks such as hepatotoxicity and required specific preparation of the patient before treatment such as 12-hour fasting and pre-post purging caused considerable inconvenience to the patient. However, successive discoveries were born out of rationale approach that contributed to the effective, more specific and more easily tolerated drugs i.e. benzimidazoles, piperazine derivatives, avermectins, pyrazinoquinoline, etc. The present approach is to identify the causative parasite on the basis of stool examination and as a result of this approach, different drugs are prescribed for different parasitic infections. Examples include thiabendazole for cutaneous larva migrans, mebendazole for ascariasis, trichiuriasis and hookworm, albendazole for inoperable cases of cystic hydatid disease, DEC for Toxocara induced visceral larva migrans and loiasis, ivermectin for onchocerciasis, praziquantel for schistosomiasis and niridazole for Dracunculus medinensis. The cure rates with these drugs is also high e.g. thiabendazole produces a cure-rate of 98% in cutaneous larva migrans while mebendazole gives cure rate of 76-95% in ascariasis, trichiuriasis and hookworm infestations. A cure rate of 96% is produced by praziquantel in schistosomiasis. Most of these drugs have broad-spectrum anthelmentic effect. The present review aims at evaluating the currently available anthelmintics with respect to their efficacy and adverse effects. Steps to prevent impending helminthic drug resistance are also discussed.

A novel 40 kDa protein from goat mammary secretions: purification, crystallization and preliminary X-ray diffraction studies

A novel 40 kDa protein has been purified from dry secretions of the mammary gland of goats. The first 15 N-terminal residues were sequenced and showed a sequence identity of 30% to a novel 39 kDa whey protein from bovine mammary secretions. The protein was crystallized by the microdialysis method. Protein was dissolved to a concentration of 40 mg ml(-1) in 0.025 M Tris-HCl pH 8.0 and equilibrated with the same buffer containing 19%(v/v) ethanol. The crystals belong to the orthorhombic space group P2(1)2(1)2(1), with unit-cell parameters a = 66.1, b = 107.8, c = 63.2 A and one molecule per asymmetric unit. Intensity data were collected to 2.9 A resolution, with a completeness of 95%. Since no similar model is available in the protein structure database, heavy-atom derivatives have been prepared and three-dimensional structure determination using the isomorphous replacement method is in progress.

Differentiation of atypical moles (dysplastic nevi) from early melanomas by dermoscopy

Several conventional and new dermoscopic criteria are highly specific for diagnosing early melanomas. Until the reliability of the dermoscopic scoring systems has been validated, the presence of any combination of these specific features should elevate the index of suspicion for melanoma and prompt a biopsy to avoid missing this cancer.

Juvenile rheumatoid arthritis with amyloid goiter: report of a case with review of the literature

Clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. A 23-yr-old female, a case of juvenile rheumatoid arthritis, developed rapidly increasing thyromegaly during the course of her illness with complaints of dyspnea and dysphagia. Thyroid function tests were within normal limits. Fine-needle aspiration cytology proved inconclusive. Total thyroidectomy was done for symptomatic relief with a preoperative clinical impression of malignancy. Histopathologic findings were consistent with amyloid goiter. The findings of this case are presented, to emphasize the difficulties in making a definite preoperative diagnosis, along with a brief review of the literature.

Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability

OBJECTIVES

To measure the effectiveness of an educational intervention designed to teach residents four essential evidence-based medicine (EBM) skills: question formulation, literature searching, understanding quantitative outcomes, and critical appraisal.

DESIGN

Firm-based, controlled trial.

SETTING

Urban public hospital.

PARTICIPANTS

Fifty-five first-year internal medicine residents: 18 in the experimental group and 37 in the control group.

INTERVENTION

An EBM course, taught 2 hours per week for 7 consecutive weeks by senior faculty and chief residents focusing on the four essential EBM skills.

MEASUREMENTS AND MAIN RESULTS

The main outcome measure was performance on an EBM skills test that was administered four times over 11 months: at baseline and at three time points postcourse. Postcourse test 1 assessed the effectiveness of the intervention in the experimental group (primary outcome]; postcourse test 2 assessed the control group after it crossed over to receive the intervention; and postcourse test 3 assessed durability. Baseline EBM skills were similar in the two groups. After receiving the EBM course, the experimental group achieved significantly higher postcourse test scores (adjusted mean difference, 21%; 95% confidence interval, 13% to 28%; P < .001). Postcourse improvements were noted in three of the four EBM skill domains (formulating questions, searching, and quantitative understanding [P < .005 for all], but not in critical appraisal skills [P = .4]). After crossing over to receive the educational intervention, the control group achieved similar improvements. Both groups sustained these improvements over 6 to 9 months of follow-up.

CONCLUSIONS

A brief structured educational intervention produced substantial and durable improvements in residents' cognitive and technical EBM skills.

Nephron-sparing surgery in a case of giant renal hydatid cyst

We report a case of a centrally located giant renal hydatid cyst managed successfully by excision of the cyst alone and preserving the renal parenchyma after clamping the main renal artery. Follow-up IVP showed good function.

Protective effects of ischemic preconditioning for liver resection performed under inflow occlusion in humans

OBJECTIVE

To determine whether ischemic preconditioning protects the human liver against a subsequent period of ischemia in patients undergoing hemihepatectomy, and to identify possible underlying protective mechanisms of ischemic preconditioning, such as inhibition of hepatocellular apoptosis.

SUMMARY BACKGROUND DATA

Ischemic preconditioning is a short period of ischemia followed by a brief period of reperfusion before a sustained ischemic insult. Recent studies in rodents suggest that ischemic preconditioning is a simple and powerful protective modality against ischemic injury of the liver. The underlying mechanisms are thought to be related to downregulation of the apoptotic pathway.

METHODS

Twenty-four patients undergoing hemihepatectomy for various reasons alternatively received ischemic preconditioning (10 minutes of ischemia and 10 minutes of reperfusion) before transection of the liver performed under inflow occlusion for exactly 30 minutes. Liver wedge and Tru-cut biopsy samples were obtained at the opening of the abdomen and 30 minutes after the end of the hepatectomy. Serum levels of aspartate transferase, alanine transferase, bilirubin and prothrombin time were determined daily until discharge. Hepatocellular apoptosis was evaluated by in situ terminal deoxynucleotidyl transferase mediated d-UTP nick end-labeling (TUNEL) assay and electron microscopy. Caspase 3 and 8 activities were measured in tissue using specific fluorometric assays.

RESULTS

Serum levels of aspartate transferase and alanine transferase were reduced by more than twofold in patients subjected to ischemic preconditioning versus controls. The analysis of a subgroup of patients with mild to moderate steatosis indicated possible increased protective effects of ischemic preconditioning. In situ TUNEL staining demonstrated a dramatic reduction in the number of apoptotic sinusoidal lining cells in the ischemic preconditioning group. Electron microscopy confirmed features of apoptosis present in control but not in ischemic preconditioning patients. There was no significant difference in caspase 3 and 8 activity when patients with ischemic preconditioning were compared with controls.

CONCLUSIONS

Ischemic preconditioning is a simple and effective modality protecting the liver against subsequent prolonged periods of ischemia. This strategy may be a more attractive technique than intermittent inflow occlusion, which is associated with increased blood loss during each period of reperfusion.