Rapid progression of HIV infection in infancy

Transmission of HIV from mother to child can occur in utero, during labor or after delivery via breast feeding. Data on the fate of babies born with HIV in India are scarce. We present details of 25 infants with perinatally acquired HIV infection (virologically confirmed) to highlight the observed high rate of morbidity and mortality within the first 18 months of life. Our findings of rapid disease progression among perinatally infected HIV positive children underline the importance of early diagnosis and treatment.

Effect of Metoprolol CR/XL on pulmonary artery pressure in chronic heart failure patients assessed by an implanted ultrasonic device with special emphasis on diurnal variation and exercise capacity

OBJECTIVE

We evaluated the impact of Metoprolol CR/XL on the diurnal and exercise induced variation on Pulmonary Artery Pressure (PAP) in patients with Chronic Heart Failure (CHF) by implanted ultrasonic device.

BACKGROUND

Metoprolol produces haemodynamic and clinical benefits in patients with chronic heart failure and improves survival rate. There is limited information about their effect on PAP, its diurnal and exercise induced variation in heart failure. This study evaluates the diurnal variation and effects of exercise capacity on PAP and impact of Metoprolol CR/XL (XL) on these variations on PAP in CHF patients.

METHODS

In this first-in-man study, ten NYHA class III/IV patients were implanted with an ultrasonic pressure-monitoring device, followed a month later by loading with MXL 25 mg/day and uptitrated every two weeks to 200 mg/day. PAP was measured at each follow up. Diurnal variation was evaluated at baseline (no MXL), 100, and 200 mg/day MXL. Treadmill Test (TMT) was performed before and at each uptitration. Echocardiography was performed at one year.

RESULTS

Uptitrating MXL caused a slight initial rise in PAP, followed by a subsequent decrease on reaching 200 mg/day dose. One patient showed repeated symptomatic rise in PAP indicating MXL intolerance and was discontinued from the uptitration. The nocturnal rise in PAP at baseline was reduced on reaching 200 mg/day MXL dose. Uptitrating MXL to 200mg7divide;day improved exercise time and metabolic equivalent tasks (METS) with no significant change in post TMT PAP. Ejection fraction also improved at one-year follow-up.

CONCLUSIONS

PAP increases post exercise and diurnally in CHF patients. Slow and careful uptitration of MXL with simultaneous non-invasive monitoring of PAP may benefit in nocturnal rise and exercise capacity in CHF patients.

Shukor S, Aziz N. Development of Sigmoidnet Based NARX Model for a Distillation Column

Distillation exhibits highly nonlinear dynamic behavior and the development of suitable nonlinear model to distillation pose a challenging problem to current process industry. In the absence of a reasonably accurate nonlinear model, distillation column is difficult to control using advanced model based control strategies. In this paper, a novel sigmoidnet based nonlinear auto-regressive with exogenous inputs (NARX) model is developed for high purity distillation column and verified using the experimentally validated first principle model. The model validation and regressor analysis proved that the developed NARX model was capable of capturing the nonlinear dynamics of a distillation column.

Personality profile among Human Immunodeficiency Virus (HIV) positives and Acquired Immunodeficiency Syndrome (AIDS) patients of injecting drug users

OBJECTIVE

The purpose of the study was to find out the various personality factors among HIV/AIDS patients of injecting drug users.

MATERIALS AND METHODS

The study was conducted during the period of July 2001 to August 2004 at Manipur State, India in which 60 samples of both male and female in the age range of 21 to 35 years were taken through the helps from R.I.M.S Hospital, Imphal, J.N. Hospital, Imphal and several NGOs of Manipur. The patients were administered 16 PF (Personality profile developed by R.B. Cattell and H.W. Eber) test in which 16 personalities were detected.

RESULTS

The profile of the respondents includes age and sex cases of HIV/ AIDS. In the sample among the HIV/AIDS patients, from the age group of 21 to 25 years consists of only 20%. Most of the patients are from 26 to 35 years consisting of two age groups, i.e., 26 to 30 years and 31 to 35 years having 40% each with total of 80%. In the survey, it has been found that majority of the HIV/AIDS patients is male which consists of 60% and remaining 40% belongs to female in the ratio of 60:40. The following four scales are used to explain personality profile: 1 Introversion vs extraversion. 2 Low anxiety vs high anxiety. 3 Emotional sensitivity vs tough poise. 4 Subdueness vs independence.

Drug resistance pattern of Mycobacterium tuberculosis in seropositive and seronegative HIV-TB patients in Pune, India

BACKGROUND & OBJECTIVE

Tuberculosis is the commonest opportunistic disease in persons infected with human immunodeficiency virus (HIV). Emergence of drug resistant isolates of M. tuberculosis highlights the need for continuous monitoring of drug resistance to antituberculosis drugs. Considering the reported high prevalence of drug resistance in HIV infected tuberculosis patients, we studied the anti-tuberculosis drug resistance pattern of M. tuberculosis in HIV seropositive and seronegative tuberculosis patients in Pune, Maharashtra, India.

METHODS

A total of 70 M. tuberculosis isolates, 30 from HIV seropositive and 40 from HIV seronegative tuberculosis patients with no previous history of anti-tuberculosis treatment, were isolated from sputum samples on Lowenstein-Jensen (LJ) medium, confirmed by conventional biochemical tests and stored at -70 degrees C. They were revived by subculturing on LJ medium and tested for drug resistance against four first-line antitubercular drugs by BACTEC Mycobacterial growth indicator tube 960 (MGIT 960) system.

RESULTS

Of the 30 isolates from HIV infected patients, 10 per cent were resistant to isoniazid (H), 6.6 per cent to streptomycin (S), 6.6 per cent to ethambutol (E) and 10 per cent were multi drug resistant (MDR). Of the 40 M. tuberculosis isolates from HIV uninfected individuals, 10 per cent were resistant to H, 2.5 per cent to S, 2.5 per cent to E, and 2.5 per cent isolates were MDR.

INTERPRETATION & CONCLUSION

The prevalence of drug resistant M. tuberculosis isolates among HIV seropositive tuberculosis patients was similar to that of HIV seronegative TB patients, indicating HIV infection may not be associated with drug resistant tuberculosis. However, considering the results from other studies and a high prevalence of HIV-TB infection in the country, monitoring of drug resistance in M. tuberculosis isolates needs prioritization to ensure success in national tuberculosis control programme.

Neonatal transportation: the effects of a national neonatal transportation programme

BACKGROUND

The transport of critically ill newborns by specialised transport teams has been shown to be associated with a significant improvement in their clinical condition on arrival at the receiving hospital.

AIM

To determine if the National Neonatal Transport Programme introduced in 2001 improved clinical condition of newborns at the end of transfer.

METHODS

A retrospective study of all 176 patients transported by the National Neonatal Transport Programme between March 2001 and March 2002.

RESULTS

Before transfer, 17% of patients were hypothermic, 2% hypoglycaemic and 11% acidotic as were 7%, 3% and 5% respectively at the end of transfer. A review of 172 neonatal transports between 1987 and 1989 revealed that 21% of patients were hypothermic, 13% hypoglycaemic and 20% acidotic at the end of transfer.

CONCLUSIONS

The National Neonatal Transport Programme has resulted in improved clinical condition of newborns at the end of transfer when compared to their condition before transfer and compared to outcomes prior to the introduction of the programme.

Giant mixed-type perinephric liposarcoma

Retroperitoneal fatty tumours are uncommon occurrences in current urologic practice, the differentials being lipomas, liposarcomas and extra-renal angiomyolipomas (AML). We report an unusual case of a 48-year-old Chinese female who presented with a 6.2 kg giant mixed-type liposarcoma in the left perinephric space, invading into the renal cortex and parenchyma. Extirpative surgery with left radical nephrectomy was performed, and histology confirmed liposarcoma with both myxoid and well-differentiated elements. The patient remains well and disease-free at 6-month follow-up. We review the literature on the diagnosis and management of these perinephric lipomatous lesions. We also discuss the diagnostic dilemma in differentiating such malignancies from benign angiomyolipomas in the perinephric area on conventional radiological imaging, and its direct implications with respect to extent of surgery and renal preservation.

Extrauterine placental site trophoblastic tumour in association with a lithopedion

AIM

We describe an unusual case of extrauterine placental site trophoblastic tumour located in pouch of Douglas in association with a lithopedion.

METHODS AND RESULTS

A 35-year-old female presented with acute abdomen and peritonitis following rectal perforation. The patient gave a history of 5 months amenorrhoea followed by vaginal bleeding 5 years prior to admission. At laparotomy, a lithopedion was found in pouch of Douglas with rectal perforation and peritonitis. The lithopedion was removed, rectal perforation was sutured and a colostomy was performed. The colostomy was closed later and tumour was seen in the colostomy wound as well as attached to the lithopedion removed previously. The patient presented with a repeated episode of rectal perforation and the tumour had spread to colon, small intestine, omentum, mesentery and right ovary.

CONCLUSION

A high-grade malignant placental site trophoblastic tumour with aggressive clinical course occurred at an extrauterine site. It complicated calcified abdominal pregnancy and resulted in repeated rectal perforation and peritonitis.

Thyroid gland papillary carcinoma with fibromatosis-like stroma: case report

Papillary carcinoma of the thyroid may show a variable degree of fibrosis of the stroma, but proliferation of the stromal fibroblasts mimicking fibromatosis is rare. There appears to be a new variant of papillary carcinoma of the thyroid associated with exuberant proliferation of the fibroblasts resembling fibromatosis. We present one such case in a 50 year old woman and succinctly reviewed the relevant literature of this rare variant. The necessity of a diligent search for a papillary carcinoma in thyroid gland which shows a proliferative fibrous lesion is stressed.

Gall bladder cancer in north eastern Libya

OBJECTIVE

Assessment of gall bladder cancer among cholecystectomy specimens.

DESIGN

Retrospective study of all cholecystectomy specimens coupled with data from clinical oncology department.

SETTING

Department of Pathology and Department of Clinical Oncology, Al Arab Medical University, Benghazi, Libya.

SUBJECT

Gall bladder cancer among cholecystectomies and the pattern of survival of these patients.

MATERIAL

Histopathology records available on all cholecystectomies performed between 1982 and 1997. Data available on staging and survival of cancer patients from clinical oncology upto 1996.

RESULTS

Eighty nine cases of gall bladder cancer were found out of 7352 cholecystectomies performed over a period of 16 years. It was found more commonly in females with a mean age of 58.1 years. It was also observed that the incidence in males above 60 years was almost equal to that of females. Gall bladder cancer when primarily detected by the pathologist in cholecystectomy specimens removed for symptomatic cholelithiasis, was mostly in stage I. Most of the patients in stage III-IV cancer died within one year whereas most of the stage I cancer patients survived more than two years.

CONCLUSION

Simple cholecystectomy is strongly advised in women above 50 years of age and in men above 60 years of age with symptomatic cholelithiasis.

Partial bifurcation and webbed root of mandibular second premolar--an uncommon variation

An eleven year old girl reported to J. S. S. Dental College with spontaneous pain in the left mandibular region. On examination, left mandibular second premolar was found to be hypoplastic and grossly destroyed. On radiographic evaluation, an uncommon variation of bifurcation at the apical one third of the root was seen while the contralateral tooth was normal. Treatment planning included extraction of the tooth and evaluation of the morphodifferentiation which showed a webbed appearance in the bifurcated root contrary to the radiographic finding. This webbed appearance could be due to hypomineralisation due to trauma to the developing roots from the infection of its predecessors.

Giant juvenile papillomatosis of the breast: report of two cases

Two cases of giant juvenile papillomatosis of the breast, a rare disease occurring in adolescent girls, are reported from Libya. Both cases had been initially misdiagnosed as phylloides tumour of the breast due to the large size of the tumours. Juvenille papillomatosis should be included in the differential diagnosis of a large breast mass, particularly in young girls.

Malakoplakia of the prostate gland--report of two cases and review of the literature

Malokoplakia of the prostate is extremely rare. We report two cases of prostatic malokoplakia in one 60-year-old and one 64-year-old Libyan man, who both were presented with enlarged prostate containing firm to hard nodules. These cases may be misdiagnosed as carcinoma clinically, but the histology points out the correct diagnosis with the presence of Michaelis-Gutmann bodies in the proliferating histiocytes.

Closed mitral valvotomy and elective ventilation in the postoperative period: effect of mild hypercarbia on right ventricular function

OBJECTIVES

It is customary to extubate patients immediately after closed mitral valvotomy. These patients often have deranged respiratory function caused by chronic lung congestion. The left ventricular function may also be subnormal after valvotomy in some patients. Therefore, elective ventilation for some duration in the postoperative period can be beneficial to these patients. This work is an attempt to find whether elective ventilation should be preferred over immediate extubation in these patients.

DESIGN

A prospective randomized study.

SETTING

The study was performed in a tertiary care hospital, and the patients are referred from the northern states of India.

PARTICIPANTS

One hundred patients undergoing elective closed mitral valvotomy were included in the initial part of the study. Ten more patients were studied to evaluate the effect of mild hypercarbia on right ventricular function after closed mitral valvotomy.

INTERVENTIONS

One hundred patients were divided into two groups of 50 each. Group 1 consisted of patients in whom the neuromuscular blockade was reversed at the end of surgery with neostigmine and atropine and the trachea was extubated. In group 2, the residual neuromuscular paralysis was not reversed and the patients were electively ventilated in the postoperative period for an average duration of 5 hours and 29 minutes +/- 1 hour and 58 minutes. In all the patients in both the groups, electrocardiogram, direct arterial blood pressure, and oxygen saturation were continuously monitored, and arterial blood gases were measured intermittently throughout the study period. Because the results showed that there was mild hypercarbia, 30 minutes after extubation in group 1, 10 more patients were studied to evaluate the effect of mild hypercarbia on right ventricular function after surgery. Patients were ventilated after surgery (F1O2 = 1) to maintain normocarbia (PaCO238.6 +/- 3.4 mmHg). Mild hypercarbia PaCO251.5 +/- 3.7 mmHg) followed by normocarbia (PaCO2 40 +/- 2.5 mmHg) was induced by adjusting the ventilator rate with a constant tidal volume. Standard hemodynamic measurements were performed at each stage.

MEASUREMENTS AND MAIN RESULTS

Although all the patients maintained satisfactory and stable hemodynamics in the postoperative period, the PaCO2 at the end of 30 minutes of extubation was significantly higher in group 1 (48.1 +/- 5.3 mmHg) as compared with group 2 (40.2 +/- 4.3 mmHg, p < 0.001). Mild hypercarbia significantly increased pulmonary vascular resistance (p < 0.01), mean pulmonary arterial pressure (p < 0.001), right ventricular stroke work (p < 0.01), right ventricular systolic pressure (p < 0.01), and right ventricular end-diastolic pressure (p < 0.001). The effect was not totally reversible with CO2 washout as all parameters except right ventricular end-diastolic pressure and pulmonary vascular resistance continued to remain significantly higher when normocarbia was restored. The significant changes in systemic hemodynamics produced by hypercarbia were increases in cardiac index, mean arterial pressure, and pulmonary capillary wedge pressure.

CONCLUSIONS

Avoidance of even mild hypercarbia, therefore, appears advisable in the early postoperative period because of potential impedence to right ventricular ejection. Continuous monitoring of end-tidal CO2 and frequent blood gas analyses should be practiced, and elective ventilation should be considered in patients with long-standing disease and pulmonary hypertension.

Malignant mesenchymoma as a primary urinary bladder tumour

A rare case of primary malignant mesenchymoma of the urinary bladder is reported in a 72 year old man. The tumour showed predominantly a leiomyosarcomatous component with foci of malignant bone, cartilage and myxomatous areas. The importance of studying multiple sections from the tumour is stressed to arrive at the proper diagnosis.

Synthesis and biological evaluation of N4-substituted imidazo- and v-triazolo[4,5-d]pyridazine nucleosides

The chemical synthesis of certain N4-substituted imidazo[4,5-d]pyridazine and v-triazolo[4,5-d]-pyridazine nucleosides is described. In both series, the 4-chloro analogues, i.e., 4-chloro-1-(2,3,5-tri-O-acetyl-beta-D-ribofuranosyl)imidazo[4,5-d]pyr idazine (5a) and 4-chloro-1-(2,3,5-tri-O-acetyl-beta-D-ribofuranosyl)-v-triazolo[4,5- d]pyridazine (5b), were used as synthons to the target nucleosides. Nucleoside 5b was far more reactive toward nucleophilic displacements than 5a. Attempted deprotection of 5b was always accompanied with displacement of the 4-chloro substituent, whereas 5a was conveniently deacetylated without loss of the chloro group. Biological evaluation of the title nucleosides included antitumor studies and substrate/inhibition studies with certain purine-metabolizing enzymes. The corresponding adenosine analogues, i.e., 2-aza-3-deazaadenosine (6a) and 2,8-diaza-3-deazaadenosine (6b), were very slowly reacting substrates and weak inhibitors of bovine adenosine deaminase, whereas the inosine analogues were highly resistant to human purine nucleoside phosphorylase. The 4-benzylamino derivatives were weak inhibitors of adenosine transport into human erythrocytes. The inosine, adenosine, and selected N4-substituted analogues exhibited no in vitro toxicity toward murine L1210 leukemia and B16 melanoma cells.

Autopsy incidence of pulmonary vascular episodes. A study of 218 cases

Pulmonary thromboembolism is a rarity in India. This common clinical impression has so far not been tested. Among 7000 autopsies between 1964 and 1980, a total of 218 cases (126 males and 92 females) were recorded to have thrombosis and/or embolism and/or infarction in the lungs. This incidence of 3.1% is far lower than that reported in the West and similar to the low incidence in Africa. Of the 218 cases, 42.6% had a cardiac disease, 18.3% had systemic septicemia, 13% had a malignancy, 12.8% had pulmonary disease, and the remaining suffered from diseases of liver, kidney, CNS, etc. Of the 218 cases, 141 (64.6%) showed only infarcts, 40 (18.3%) had only thromboemboli, and 37 (16.9%) showed both events. In view of the overlap among these three conditions and their essential pathophysiologic identity (thrombus/embolism/infarction), it is suggested that these be grouped under the name "pulmonary vascular episode."