Pulmonary Cryptococcosis in HIV- sero-negative patients: case series from India

Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and radiological features. It is more frequently associated with immuno-suppressed conditions especially acquired immuno-deficiency syndrome (AIDS) and pulmonary tuberculosis (PTB). Four cases of pulmonary cryptococcosis were diagnosed over a period of eleven years. All patients in this case series were human immune-deficiency virus (HIV)-negative. The predisposing factors in these patients were diabetes mellitus (DM), acute lymphoblastic leukaemia (ALL), post-partum and pregnancy in one each of the patients. Relapse was seen in two cases. All the patients survived due to strict follow-up. Pulmonary cryptococcosis is common in non-AIDS patients and it warrants rapid diagnosis, treatment and follow-up to prevent relapse.

Emergence of influenza A (H1N1) PDM09 in the remote Islands of India--a molecular approach

BACKGROUND

A disease outbreak of A (H1N1) PDM09 was reported in Andaman and Nicobar islands in 2009 with an attack rate of 33.5% among settler population and 26.3% among the aboriginal Nicobarese tribe. During the ongoing outbreak of A (H1N1) PDM09 disease in different parts of the world, a subject working in Dubai city of Saudi Arabia, came to Port Blair, following which the pandemic triggered for the first time in these Islands.

MATERIALS AND METHODS

During the period August 2009 to January 2011, 30 confirmed cases of Influenza A (H1N1) PDM09 virus infection was detected. To understand the genetic relationship, the NA gene sequences of the viruses were phylogenetically analysed together along with the virus sequence isolated from other parts of the world.

RESULT

Formation of multiple clusters were observed, with the sequences of Andaman Islands, mainland India, Mexico, Saudi Arabia and few other counties clustering together. The sequence analysis data revealed that there was no specific mutation conferring resistance to oseltamivir among the Andaman A (H1N1) PDM09 virus isolates. The result of phylogenetic analysis have also revealed that the A (H1N1) PDM09 virus might have spread in these remote Islands of India via the subject from Saudi Arabia/Dubai.

CONCLUSION

A (H1N1) PDM09 Influenza outbreak have highlighted the need to strengthen the region-specific pandemic preparedness plans and surveillance strategies.

Free thin anterolateral thigh flap for post-burn neck contractures - a functional and aesthetic solution

Neck contractures after burn injuries produce restrictions in motion and unacceptable aesthetic outcomes. Although different methods of reconstruction have been used in the treatment of this ailment, a limited and unsatisfactory outcome often results. Free thin anterolateral flaps have been found to be a good single stage option for reconstruction of post-burn contractures of the neck. In our study, 11 patients with post flame burn contractures of the neck underwent surgical release and coverage by a free thin anterolateral thigh flap. Patients were followed up for an average of five years and various aspects of functional and aesthetic rehabilitation were assessed. Our findings revealed that the free thin anterolateral flaps covered the defects over anterior and lateral aspects of the neck with good colour match and contour. Furthermore, none of the flaps had any significant early or delayed complications. Two cases had to be reoperated for partial loss of flaps and all patients were satisfied with functional and aesthetic outcomes. We therefore consider free thin anterolateral thigh flaps to provide a good single stage reconstruction for post-burn cervical contractures with good functional and aesthetic outcomes.

Pharyngeal airway analysis in obese and non-obese patients with obstructive sleep apnea syndrome

BACKGROUND

Sleep disorders are a group of disorders characterized by abnormalities of respiration during sleep. OSA (Obstructive Sleep Apnea) is characterized by the repetitive episodes of complete or partial collapse of the upper airway during sleep, causing a cessation or a significant reduction of airflow.

METHOD

The study population consisted of 30 control patients (AHI ≤ 5) events per hour, 74 patients with OSAS, including 34 Obese (BMI ≥ 27) and 40 non-obese (BMI ≤ 27). Polysomnography and measurements of 21 cephalometric variables were carried out for all patients with OSAS.

RESULTS

Obese patient with OSAS showed significant difference in following cephalometric parameters: (1) PAS (2) MPT (3) MPH (4) PNS-P (5) SAS. In addition, obese patient had longer tongue (TGL), more anteriorly displaced hyoid bones (H-VL) and more anterior displacement of mandible (G-VL) when compared with control groups. The findings of non-obese patients when compared to controls showed all the findings of obese patients and in addition to that narrow bony oropharynx were significant. Step wise regression analysis showed the significant predictors for all patients were MPH, PNS-P, bony nasopharynx (PNSBa), MPT, and palatal length (ANS-PNS) for AHI. The significant predictors for obese OSA (obstructive sleep apnea) group were MAS while for non-obese OSA group ANS-PNS was significant predictor for AHI (apnea-hypopnea index).

CONCLUSION

Craniofacial landmarks such as increase in hyoid distance, longer tongue and soft palate with increased thickness and narrowing of superior pharyngeal, oropharyngeal and hypopharyngeal airway space may be important risk factors for development of OSAS.

Abstract 1024: T11TS impedes glioma angiogenesis by attenuating brain endothelial Angiopoietin-1/Tie2 signaling and inducing apoptosis of glioma associated brain endothelial cells

Malignant gliomas are highly invasive primary brain tumors resistant to conventional treatments primarily because of sustained angiogenesis and infiltrative nature. Despite multimodal therapeutic interventions high grade gliomas have a propensity for recurrence. We recently reported that T11-target structure (T11TS), a membrane glycopeptide isolated from sheep erythrocyte membrane inhibits VEGF signaling and prosurvival PI3K/Akt pathway in glioma associated brain endothelial cells. Angiopoietin signaling mediated through endothelial Tie2 receptors is a potent mediator of glioma angiogenesis. Apoptosis of tumor endothelial cells acts as a crucial regulator of tumor angiogenesis and some angiogenesis inhibitors mediate their anti-angiogenic effect through induction of endothelial cell apoptosis. The effect of T11TS on brain endothelial cell Angiopoietin-1/Tie2 signaling and endothelial cell apoptosis has not been investigated so far. The goal of this study is to determine the effects of T11TS administration on endothelial Angiopoietin-1/Tie 2 signaling and on apoptosis of brain endothelial cells in a chemically induced glioma model. Furthermore, this study investigated the mechanistic details of brain endothelial cell apoptosis induction caused by in vivo T11TS therapy. Expression of angiopoietin-1, Tie2, phospho-Tie2 proteins, apoptotic pathway regulator proteins and caspases were determined by flowcytometry, immunoblotting, immunofluorescence imaging and in situ immunofluorescent staining. Apoptosis in brain endothelial cells was directly evaluated by flowcytomeric Annexin V-PI assay and mitochondrial membrane JC-1 assay. T11TS administration in glioma induced rats significantly downregulate Angiopoietin-1 expression and Tie2 receptor activation in brain endothelial cells thereby blocking Angiopoietin-1/Tie2 signaling. T11TS therapy triggered dose-dependent externalization of membrane phosphatidylserine, reduction in mitochondrial membrane potential and cleavage of caspase 3 which strongly indicated induction of apoptosis in glioma associated brain endothelial cells. T11TS administration in glioma was found to activate both intrinsic and extrinsic pathways of apoptosis by modulating expression of apoptotic regulator proteins like p53, Bax, Bcl-2, Fas and FasL, triggering cytochorome c release into cytosol and activating caspases 8, 3 and 9 in brain endothelial cells. T11TS administration also stimulated cleavage of Bid in glioma associated brain endothelial cells. This preclinical study demonstrated that blockage of Angiopoietin-1/Tie2 signaling in glioma associated brain endothelial cells and induction of apoptosis in brain endothelial cells constitute the underlying mechanistic events that contribute to the anti-angiogenic efficacy of T11TS in malignant glioma.

Citation Format: Debanjan Bhattacharya, Suhnrita Chaudhuri, Swapna Chaudhuri. T11TS impedes glioma angiogenesis by attenuating brain endothelial Angiopoietin-1/Tie2 signaling and inducing apoptosis of glioma associated brain endothelial cells. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1024. doi:10.1158/1538-7445.AM2014-1024

Metaplastic carcinoma of breast

Metaplastic carcinomas of breast are a heterogeneous group of malignant tumours in which part or all of the carcinomatous epithelium is transformed into a nonglandular (metaplastic) growth process. This rare neoplasm usually runs an aggressive course. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10320 Journal of Pathology of Nepal (2014) Vol. 4, 594-596

Impact of maternal hepatitis B virus coinfection on mother-to-child transmission of HIV

OBJECTIVES

Despite high hepatitis B virus (HBV) endemicity in various resource-limited settings (RLSs), the impact of maternal HIV/HBV coinfection on infant health outcomes has not been defined. We aimed to assess the prevalence of HBV coinfection among HIV-infected pregnant women and its impact on HIV transmission and infant mortality.

METHODS

In this study, the seroprevalence of HBV coinfection was determined among HIV-infected pregnant women enrolled in the Six-Week Extended-Dose Nevirapine (SWEN) India trial. The impact of maternal HIV/HBV coinfection on mother-to-child transmission (MTCT) of HIV and infant mortality was assessed using univariate and multivariate logistic regression analysis.

RESULTS

Among 689 HIV-infected pregnant Indian women, 32 (4.6%) had HBV coinfection [95% confidence interval (CI) 3.4%, 5.3%]. HBV DNA was detectable in 18 (64%) of 28 HIV/HBV-coinfected women; the median HBV viral load was 155 copies/mL [interquartile range (IQR) < 51-6741 copies/mL]. Maternal HIV/HBV coinfection did not increase HIV transmission risk [adjusted odds ratio (aOR) 1.06; 95% CI 0.30, 3.66; P = 0.93]. Increased odds of all-cause infant mortality was noted (aOR 3.12; 95% CI 0.67, 14.57; P = 0.15), but was not statistically significant.

CONCLUSIONS

The prevalence of active maternal HBV coinfection in HIV-infected pregnant women in India was 4.6%. HIV/HBV coinfection was not independently associated with HIV transmission.

Assessment of lexical semantic judgment abilities in alcohol-dependent subjects: an fMRI study

Neuropsychological studies have shown that alcohol dependence is associated with neurocognitive deficits in tasks requiring memory, perceptual motor skills, abstraction and problem solving, whereas language skills are relatively spared in alcoholics despite structural abnormalities in the language-related brain regions. To investigate the preserved mechanisms of language processing in alcohol-dependents, functional brain imaging was undertaken in healthy controls (n=18) and alcohol-dependents (n=16) while completing a lexical semantic judgment task in a 3 T MR scanner. Behavioural data indicated that alcohol-dependents took more time than controls for performing the task but there was no significant difference in their response accuracy. fMRI data analysis revealed that while performing the task, the alcoholics showed enhanced activations in left supramarginal gyrus, precuneus bilaterally, left angular gyrus, and left middle temporal gyrus as compared to control subjects. The extensive activations observed in alcoholics as compared to controls suggest that alcoholics recruit additional brain areas to meet the behavioural demands for equivalent task performance. The results are consistent with previous fMRI studies suggesting compensatory mechanisms for the execution of task for showing an equivalent performance or decreased neural efficiency of relevant brain networks. However, on direct comparison of the two groups, the results did not survive correction for multiple comparisons; therefore, the present findings need further exploration.

Prostaglandin E1-induced Catalepsy in the Rat: Role of Putative Neutrotransmitters

Prostaglandin E1 (PGE1) produced dose-related catalepsy in rats when administered intracerebroventricularly. PGE1 induced catalepsy was significantly inhibited after pretreatment with pharmacological agents known to attenuate central serotonergic and cholinergic activity. It was also inhibited by PGF2α and naloxone. On the contrary, treatments enhancing central dopaminergic activity also reduced the cataleptic effect of PGE1. The results suggest that PGE1 induces catalepsy in rats by modulating activity of central neurotransmitters.

T11TS inhibits glioma angiogenesis by modulation of MMPs, TIMPs, with related integrin αv and TGF-β1 expressions

During glioma development, angiogenesis plays a crucial role in growth and vascularization of primary brain tumors. T11 target structure (T11TS), a bioactive molecule, has been documented as an anti-neoplastic agent in glioma-induced rats and also in human glioma in vitro. This novel molecule induces apoptosis of tumor cells by way of immune potentiation and impairs the glioma cell cycle, but its role in glioma angiogenesis has not been worked out in detail. Matrix metalloproteinases (MMPs) are enzymes promoting tumor angiogenesis by enzymatically remodeling the extracellular matrix and altering surface protein expression such as integrin αv and the matrix-bound proteins like TGF-β1. The present study was formulated to assess the efficacy of T11TS in the modulations of MMP-2 and -9 and their endogenous inhibitors (TIMP-1 and TIMP-2) as well as modulations of integrin αv and TGF-β1 in glioma-induced rats and also on the phenotypic markers of endothelial cells (CD31 and CD34). The parameters used were zymography, western blot, and flow cytometric analyses. It was observed that T11TS administration significantly downregulates the expression of matrix metalloproteinase-2 and -9 along with its ligand integrin αv and upregulates TIMP-1 and TIMP-2. In situ immunofluorescence and FACS results revealed that T11TS administration decreased the expression of the phenotypic markers (CD31/PECAM1, CD34), inhibiting the cell grip and also downregulating TGF-β1 expression (ELISA) from microglia cells in the glioma microenvironment. These results suggest that T11TS suppresses the expression of positive angiogenic growth factors and potentiates the expression of negative regulators in glioma-associated endothelial cells (ECs), resulting in an anti-angiogenic effect on glioma-induced angiogenesis.

Assessment of abstract reasoning abilities in alcohol-dependent subjects: an fMRI study

INTRODUCTION

Chronic alcohol abuse has been traditionally associated with impaired cognitive abilities. The deficits are most evident in higher order cognitive functions, such as abstract reasoning, problem solving and visuospatial processing. The present study sought to increase current understanding of the neuropsychological basis of poor abstract reasoning abilities in alcohol-dependent subjects using functional magnetic resonance imaging (fMRI).

METHODS

An abstract reasoning task-based fMRI study was carried out on alcohol-dependent subjects (n = 18) and healthy controls (n = 18) to examine neural activation pattern. The study was carried out using a 3-T whole-body magnetic resonance scanner. Preprocessing and post processing was performed using SPM 8 software.

RESULTS

Behavioral data indicated that alcohol-dependent subjects took more time than controls for performing the task but there was no significant difference in their response accuracy. Analysis of the fMRI data indicated that for solving abstract reasoning-based problems, alcohol-dependent subjects showed enhanced right frontoparietal neural activation involving inferior frontal gyrus, post central gyrus, superior parietal lobule, and occipito-temporal gyrus.

CONCLUSIONS

The extensive activation observed in alcohol dependents as compared to controls suggests that alcohol dependents recruit additional brain areas to meet the behavioral demands for equivalent task performance. The results are consistent with previous fMRI studies suggesting decreased neural efficiency of relevant brain networks or compensatory mechanisms for the execution of task for showing an equivalent performance.

Abstract C5: T11TS arrests angiogenic signaling in malignant glioma by attenuating brain endothelial cell angiopoietin-1/Tie2 expression and inducing apoptosis in glioma associated brain endothelial cells

Malignant gliomas are highly aggressive primary brain tumors resistant to conventional treatments mainly because of sustained uncontrolled angiogenesis. Limited efficacies of currently available treatments necessitate development of multi-level targeted anti-angiogenic therapy for treatment of malignant glioma. Previously we reported that sheep erythrocyte membrane glycopeptide T11 target structure (T11TS) therapy in a rodent glioma model inhibits brain endothelial cell VEGF signaling and downstream PI3K/Akt/eNOS pathway. The angiopoietin-1/Tie2 signaling operative in brain endothelial cells is implicated in glioma angiogenesis but the role of T11TS therapy on pro-angiogenic Ang-1/Tie2 axis has not been determined yet. Induction of endothelial cell apoptosis is a common mechanism of action of many anti-angiogenic agents that restrict tumor progression. The purpose of the present study is to investigate the effect of T11TS therapy in regulation of angiopoietin-1/Tie2 signaling in glioma associated brain endothelial cells and to identify whether T11TS therapy triggers apoptosis in glioma associated brain endothelial cells. Additionally, the study evaluated the apoptotic pathways and proteins involved in T11TS induced apoptosis of brain endothelial cells. Primary brain endothelial cells isolated from the cerebral cortices of glioma induced rats before and after T11TS therapy were used for experiments. Expression of angiopoietin-1, Tie2, phospho-Tie2, and apoptotic pathway regulator proteins and caspases in brain endothelial cells were determined by flowcytometry, immunoblotting, immunofluorescent imaging, and immunohistochemical staining of rat cerebral sections. Flow cytometric Annexin V-PI assay and JC-1 assay were employed for detection of apoptosis in glioma associated brain endothelial cells. Our findings revealed that T11TS therapy significantly downregulates angiopoietin-1 and Tie2 receptor expression and activation in glioma associated brain endothelial cells. T11TS therapy induced apoptotic death of glioma associated brain endothelial cells as evidenced from membrane phosphatidylserine translocation and reduction of mitochondrial membrane potential. T11TS therapy stimulated both mitochondrial and extrinsic pathways of apoptosis by activating caspases 9, 3, and 8, triggering cleavage of Bid and modulating expression of apoptotic regulator proteins like p53, Bax, Bcl-2, Fas, and FasL in brain endothelial cells.

Blockage of Ang-1/Tie2 signaling in brain endothelial cells and induction of intrinsic and extrinsic pathway mediated apoptosis in glioma associated brain endothelial cells are the underlying mechanistic events contributing to the anti-angiogenic action of T11TS therapy in malignant glioma.

Citation Information: Mol Cancer Ther 2013;12(11 Suppl):C5.

Citation Format: Debanjan Bhattacharya, Swapna Chaudhuri. T11TS arrests angiogenic signaling in malignant glioma by attenuating brain endothelial cell angiopoietin-1/Tie2 expression and inducing apoptosis in glioma associated brain endothelial cells. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr C5.

Dysregulated STAT1-SOCS1 control of JAK2 promotes mammary luminal progenitor cell survival and drives ERα(+) tumorigenesis

We previously reported that STAT1 expression is frequently abrogated in human estrogen receptor-α-positive (ERα(+)) breast cancers and mice lacking STAT1 spontaneously develop ERα(+) mammary tumors. However, the precise mechanism by which STAT1 suppresses mammary gland tumorigenesis has not been fully elucidated. Here we show that STAT1-deficient mammary epithelial cells (MECs) display persistent prolactin receptor (PrlR) signaling, resulting in activation of JAK2, STAT3 and STAT5A/5B, expansion of CD61(+) luminal progenitor cells and development of ERα(+) mammary tumors. A failure to upregulate SOCS1, a STAT1-induced inhibitor of JAK2, leads to unopposed oncogenic PrlR signaling in STAT1(-/-) MECs. Prophylactic use of a pharmacological JAK2 inhibitor restrains the proportion of luminal progenitors and prevents disease induction. Systemic inhibition of activated JAK2 induces tumor cell death and produces therapeutic regression of pre-existing endocrine-sensitive and refractory mammary tumors. Thus, STAT1 suppresses tumor formation in mammary glands by preventing the natural developmental function of a growth factor signaling pathway from becoming pro-oncogenic. In addition, targeted inhibition of JAK2 may have significant therapeutic potential in controlling ERα(+) breast cancer in humans.

Shigellosis in Bay of Bengal Islands, India: clinical and seasonal patterns, surveillance of antibiotic susceptibility patterns, and molecular characterization of multidrug-resistant Shigella strains isolated during a 6-year period from 2006 to 2011

This study aims to determine the clinical features and seasonal patterns associated with shigellosis, the antimicrobial resistance frequencies of the isolates obtained during the period 2006-2012 for 22 antibiotics, and the molecular characterization of multidrug-resistant strains isolated from endemic cases of shigellosis in the remote islands of India, with special reference to fluoroquinolone and third-generation cephalosporins resistance. During the period from January 2006 to December 2011, stool samples were obtained and processed to isolate Shigella spp. The isolates were evaluated with respect to their antibiotic resistance pattern and various multidrug resistance determinants, including resistance genes, quinolone resistance determinants, and extended-spectrum β-lactamase (ESBL) production. Morbidity for shigellosis was found to be 9.3 % among children in these islands. Cases of shigellosis occurred mainly during the rainy seasons and were found to be higher in the age group 2-5 years. A wide spectrum of resistance was observed among the Shigella strains, and more than 50 % of the isolates were multidrug-resistant. The development of multidrug-resistant strains was found to be associated with various drug-resistant genes, multiple mutations in the quinolone resistance-determining region (QRDR), and the presence of plasmid-mediated quinolone-resistant determinants and efflux pump mediators. This report represents the first presentation of the results of long-term surveillance and molecular characterization concerning antimicrobial resistances in clinical Shigella strains in these islands. Information gathered as part of the investigations will be instrumental in identifying emerging antimicrobial resistance, for developing treatment guidelines appropriate for that community, and to provide baseline data with which to compare outbreak strains in the future.

Cyanidiales diversity in Yellowstone National Park

The Cyanidiales are unicellular red algae that are unique among phototrophs. They thrive in acidic, moderately high-temperature habitats typically associated with geothermally active regions, although much remains to be learned about their distribution and diversity within such extreme environments. We focused on Yellowstone National Park (YNP), using culture-dependent efforts in combination with a park-wide environmental polymerase chain reaction (PCR) survey to examine Cyanidiales diversity and distribution in aqueous (i.e. submerged), soil and endolithic environments. Phylogenetic reconstruction of Cyanidiales biodiversity demonstrated the presence of Cyanidioschyzon and Galdieria lineages exhibiting distinct habitat preferences. Cyanidioschyzon was the only phylotype detected in aqueous environments, but was also prominent in moist soil and endolithic habitats, environments where this genus was thought to be scarce. Galdieria was found in soil and endolithic samples, but absent in aqueous habitats. Interestingly, Cyanidium could not be found in the surveys, suggesting this genus may be absent or rare in YNP. Direct microscopic counts and viable counts from soil samples collected along a moisture gradient were positively correlated with moisture content, providing the first in situ evidence that gravimetric moisture is an important environmental parameter controlling distribution of these algae.

Genetic characterization of Fasciola gigantica from different geographical regions of India by ribosomal DNA markers

Ribosomal DNA sequences of the second internal transcribed spacer (ITS-2) and 28S ribosomal DNA (618 bp) of Fasciola gigantica collected from cattle and buffaloes from four different geographical locations of India, were characterized for genotyping. ITS-2 sequence was analyzed in 28 worms that was typical of F. gigantica and differed at six positions, with one of these being a distinguishing deletion (T) at the 327th position in F. gigantica relative to F. hepatica. However, Fasciola specimens also showed intraspecies sequence polymorphism in the ITS-2, with two different ITS-2 sequences existing in the ribosomal DNA (rDNA) array within a single Fasciola worm. One of the sequences was identical to that of F. gigantica and the other showed extensive sequence polymorphism in the ITS-2. Using BspH1-restriction fragment length polymorphism, six variable ITS-2 sequences in F. gigantica were identified within these parasite specimens and were found distributed in these four geographical regions. 28S rDNA sequence of 24 flukes, collected from the above four geographical regions, showed a single nucleotide polymorphism at 284th nucleotide (G/A). Analyzing the sequence data of 28S rDNA of F. gigantica available from some African and Asian countries for this polymorphic 284th nucleotide position, it is proposed that there are two basic lineages of the F. gigantica for 28S rDNA existing in the fluke populations from five African and several Asian countries.