Pyomositis: a report of three cases

Pyomyositis, a subacute bacterial infection of muscles, is uncommon in children. Three children with pyomyositis and multiple abscesses caused by Staphylococcus aureus are reported. The intercostal muscles were involved in one case, the paraspinal muscles in another and in the third there was associated septic arthritis.

NeuralWISP: A Wirelessly Powered Neural Interface With 1-m Range

We present the NeuralWISP, a wireless neural interface operating from far-field radio-frequency RF energy. The NeuralWISP is compatible with commercial RF identification readers and operates at a range up to 1 m. It includes a custom low-noise, low-power amplifier integrated circuit for processing the neural signal and an analog spike detection circuit for reducing digital computational requirements and communications bandwidth. Our system monitors the neural signal and periodically transmits the spike density in a user-programmable time window. The entire system draws an average 20 muA from the harvested 1.8-V supply.

Antiviral activity of ancient system of ayurvedic medicinal plant Cissus quadrangularis L. (Vitaceae)

Partially purified methanolic extract of Cissus quadrangularis (belonging to Vitaceae member, South Indian medicinal plant) have been explored for antiviral activity and their phytochemical characterisation. In vitro antiviral activity against HSV type1 and 2, and Vero cells at non-cytotoxic concentration were determined. HSV1 and HSV2 showed more sensitivity against the partially purified compound. Phytochemical analysis showed the presence of the Steroids and Terpenoids.

A case-control study of tobacco smoking and tuberculosis in India

OBJECTIVES

To evaluate the role of smoking as a risk factor for the development of pulmonary tuberculosis.

MATERIALS AND METHODS

A total of 111 sputum smear-positive patients of pulmonary tuberculosis and 333 controls matched for age and sex were interviewed according to a predesigned questionnaire.

RESULTS

The adjusted odd ratio of the association between tobacco smoking and pulmonary tuberculosis was 3.8 (95% confidence interval, 2.0 to 7.0; P value, < 0001). A positive relationship between pack years, body mass index and socioeconomic class was also observed.

CONCLUSION

There is a positive association between tobacco smoking and pulmonary tuberculosis.

Structural and vibrational studies of molecular conductors using quantum mechanical methods: 1,3-Dithiole-2-thione, 1,3-dithiole-2-one, 1,3-dioxole-2-one and 1,3-dioxole-2-thione

Computations were carried out by employing the RHF and density functional theory (DFT) methods to investigate the geometries, atomic charges, harmonic vibrational frequencies for the 1,3-dithiole-2-thione (DTT), 1,3-dithiole-2-one (DTO), 1,3-dioxole-2-thione (DOT) and 1,3-dioxole-2-one (DOO) molecules and their radical cations. The geometrical parameters and atomic charges on various atomic sites of the DTT and DOT molecules and their radical cations suggest extended conjugation in these systems. Contrary to this, for the DOO(+) and DTO(+) ions there is no evidence in favour of such conjugation, however, the neutral molecules exhibit some conjugation. Harmonic forced field and vibrational mode calculations provided convincing theoretical evidence for the reassignment of some fundamental vibrational modes for all the four molecules. In going from the neutral species to the charged ions for all the four cases the CC stretching frequency is found to decrease drastically. The CS stretching frequency reduces drastically for the DTT and DOT molecules as compared to their radical cations whereas the CO stretching frequency is found to increase in going from the neutral molecule to its radical cation for the DOO and DTO molecules. The ring stretching mode with a(1) symmetry and CC and CO/S stretching modes in these molecules appear to help in conversion of neutral molecule into respective radical cation and neighbouring radical cation into respective neutral molecule. Thus, there appears the feasibility of stretching vibrational mode coupling with electron transfer.

A study of skin sensitivity to various allergens by skin prick test in patients of nasobronchial allergy

OBJECTIVE

To study skin sensitivity to various allergens in patients of nasobronchial allergy.

MATERIALS AND METHODS

2880 skin prick tests with 60 allergens were performed in 48 patients of nasobronchial allergy.

RESULTS

Most common offending allergens were insects (21.2%), followed by dusts (12.0%), pollens (7.8%), animal dander (3.1%), and fungi (1.3%). The common insect antigen were locust female (33.3%) followed by locust male (25%), grasshopper (20.8%), cricket (16.7%), cockroach female (16.7%) and cockroach male (14.6%). Common dust allergens were house dust, wheat dust, cotton mill and paper dust. Among pollens, Amaranthus spinosus, Argemone mexicana, Adhatoda vasica, Ailanthus and Cannabis were found to be common allergens. In animal danders common offending allergens were cow dander and dog dander. Among fungi Aspergillus fumigatus, Aspergillus flavus, Alternaria teneis and Fusarium sodani were common allergens. Patients of bronchial asthma had associated allergic rhinitis in 80% cases.

CONCLUSION

Common allergens in patients of nasobronchial allergy were identified. The data may prove useful in of allergen avoidance and immunotherapy in these patients.

Assessment of doctors' knowledge regarding tuberculosis management in Lucknow, India: a public-private sector comparison

OBJECTIVE

India tops the list of 22 high-burden tuberculosis (TB) countries. India adopted directly observed treatment - short course (DOTS) under the Revised National Tuberculosis Control Programme (RNTCP) in 1992 and public-private mix DOTS in 2002. This study was conducted to assess the knowledge of doctors in the public and private sectors regarding TB control and management.

STUDY DESIGN

Cross-sectional study.

METHODS

This study used a self-reported questionnaire based on the RNTCP technical and operational guidelines. One hundred and forty-one doctors were recruited through census sampling; all were registered with the Chest Physicians Association and treating TB using allopathic medicine. The list of doctors was obtained from Lucknow District TB Office, which annually updates and manages the members list of the Chest Physicians Association. This study was conducted in Lucknow, India in February-March 2007.

RESULTS

Of 141 doctors, 71% had specialized medical education for treating TB, 60% had received RNTCP training and 69% reported that they follow DOTS methodology for TB treatment. Fifty-six percent of doctors worked in the public sector and 44% worked in the private sector. Forty-nine percent of doctors working in the public sector and 53% working in the private sector correctly reported all TB symptoms as per the RNTCP guidelines. Sixty-six percent of doctors in the public sector and 39% in the private sector reported the correct technique for sputum sampling. Public sector doctors demonstrated better knowledge of drug regimens for sputum smear-positive and sputum smear-negative TB than private sector doctors. Statistical analysis indicated that doctors in the public sector had 2.1 times better knowledge than private sector doctors (odds ratio 2.1; P=0.05).

CONCLUSION

Health policy managers and DOTS implementers should encourage all doctors, particularly private sector doctors, to receive RNTCP training and follow DOTS methodology. Improvement is needed in RNTCP training, and emphasis needs to be given to correct diagnosis, management and follow-up of TB patients.

Lumbar subcutaneous shunt: a novel technique for therapeutic decision making in normal pressure hydrocephalus (NPH) and benign intracranial hypertension (BIH)

Selecting patients who will benefit from a permanent CSF diversion procedure in benign intracranial hypertension (BIH) or communicating hydrocephalus due to normal pressure hydrocephalus (NPH) has inherent problems. The percutaneous introduction of a lumbar subcutaneous shunt (LSS) under local anaesthesia facilitates both a prolonged CSF drainage under aseptic conditions and also elicits an adequate clinical response. We describe the technique of a lumbar subcutaneous shunt and our experience with its use in patients with BIH and NPH. Postprocedure changes in the patients' clinical status were noted. Patients with a transient clinical improvement underwent a subsequent definitive CSF diversion; those with a sustained clinical improvement or no change in symptoms had no further procedure.

Isoniazid induced gynaecomastia: a case report

Gynaecomastia due to anti-tubercular chemotherapy is a rare side effect. Isoniazid causing breast tissue enlargement has been very rarely reported. We report a 60-year old, male patient of Pulmonary Tuberculosis who was started on antituberculous treatment (ATT) with rifampicin (R), isoniazid (H), ethambutol (E) and pyrazinamide (Z) together for initial two months and R, H & E thereon. After five months of initiation of treatment, while receiving RHE, he developed painful bilateral gynaecomastia. Isoniazid was stopped and patient was continued on R & E till completion of the treatment up to nine months. After stopping isoniazid, his breast swelling subsided to some extent and became non-tender. Follow up, at six months, after stopping the course of treatment, patient was asymptomatic except for slight bilateral non-tender breast enlargement.

The role of hypoxia in recurrence following resection of Dukes' B colorectal cancer

GOALS

Tumour hypoxia has been shown to be a predictor of early distant relapse in node-negative breast and cervical cancer. The purpose of the present study was to determine the role of hypoxia in predicting patients who are at high risk of disease recurrence in Dukes B colorectal cancers.

MATERIALS AND METHODS

Archival tissue was retrieved from 52 patients who had undergone surgical resection for primary colorectal cancer. Tissue micro-arrays were constructed using tissue from the margin and the centre of the tumour. Hypoxia markers hypoxia-inducible factor (Hif)-1 alpha, vascular endothelial growth factor (VEGF), carbonic anhydrase (CA)-9 and glucose transporter (Glut)-1 were visualised using immunohistochemical detection and quantified using semi-quantitative analysis of the digitised images. Clinical details and outcome data were retrieved by case note review and collated with hypoxia markers data in a statistical database.

RESULTS

Primary colorectal cancers with a high Hif-1 alpha expression tended to have a significantly worse disease-free survival (log rank p < 0.001) and overall survival (log rank p = 0.012). VEGF was also a significant predictor of disease recurrence in primary colorectal cancers (p = 0.015). Significant correlations were also noted between Hif-1 alpha and VEGF (Pearson's p = 0.009). Glut-1 and CA-9 did not show a similar pattern with no differences in the expression pattern and no correlation observed with any of the markers. Multivariate analysis of prognostic factors showed vascular invasion (p < 0.001) and Hif-1 alpha at the tumour margin (p < 0.001) to be independent predictors for the development of liver metastases.

CONCLUSION

These results suggest an important role for Hif-1 alpha and VEGF in colorectal cancer progression, with both markers biological mechanisms directly interlinked through the hypoxic pathway. Identification of high-risk patients using the above factors will improve treatment strategies in node-negative disease and help improve patient outcome.

Bilateral chylothorax in a child after mild trauma

Chylothorax is a life-threatening form of pleural effusion with a varied aetiology. In this report, we describe the case of a child who developed bilateral chylothorax following minor trauma which responded well to conservative management.

A follow up study on revised national tuberculosis control programme (rntcp): results from a single centre study

OBJECTIVE

To know the follow up status of tuberculosis patients after 1 year of completion of treatment in RNTCP. MATERIALS #ENTITYSTARTX00026;

METHODS

Those patients of tuberculosis, who were registered from June 2003 to June 2004 at DOTS centre of our institution, were followed up at their homes after one year of completion of treatment between August 2005 and August 2006, with the help of health visitor. Patients were followed up clinically and symptomatic patients were also followed radiologically as well as bacteriologicalty. Results of the study were recorded in terms of number of patients remained asymptomatic, number of patients relapsed and number of patients died.

RESULTS

Out of 237 patients registered, 8 patients died during treatment period, 12 patients defaulted the treatment, the number of failures was 5 and 212 patients were declared cured/treatment completed. Out of these 212 patients 60 were unavailable for interview due to various reasons. The study observed that out of a total of 152 patients interviewed, 137 patients (90.1%) of remained asymptomatic, 11 patients (7.2%) had relapsed and 4 patients (2.6%) died during follow up.

CONCLUSION

The study observed that majority of patients (90.1%) re-mained asymptomatic after the completion of one year of treatment under DOTS.

Clinical trial: the incidence and early mortality after peptic ulcer perforation, and the use of low-dose aspirin and nonsteroidal anti-inflammatory drugs

BACKGROUND

It is not clear whether the incidence or early mortality related to peptic ulcer perforation has changed.

AIM

To evaluate the incidence and mortality related to peptic ulcer perforation while considering the intake of low-dose aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

METHODS

We recorded the numbers and details of all patients presenting in our region of Scotland with perforation between 1997 and 2006 including demography, drug usage and 30-day mortality.

RESULTS

In subjects aged >65 years, the annual incidence of perforation was 32.7 per 10(5) of the age-specific population, of whom 10.7 per 10(5) were taking low-dose aspirin and 12.0 taking NSAIDs. These were all significantly higher (P < 0.001) than the corresponding incidence in subjects aged < or =65 years (6.6 per 10(5) overall, 1.1 taking aspirin and 2.5 taking NSAIDs). There was an increasing trend with time in the number of patients taking NSAIDs (chi(2) = 4.57, P = 0.03). Using univariate analysis, 30-day mortality was associated with aspirin [odds ratio, 2.32 (95% C.I., 1.20-4.47), P = 0.01] but not with NSAIDs. The strongest predictors of mortality were increasing age and comorbidity.

CONCLUSIONS

Perforation remains common in elderly patients including users of NSAIDs and aspirin. Early mortality is also noted in association with increasing age and comorbidity, but not independently with drug intake.

Identification and characterization of CFTR gene mutations in Indian CF patients

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This study was performed on Indian CF patients (n = 50) to investigate the spectrum of mutations in the CFTR gene and their association with intragenic and extragenic marker haplotypes. We report identification of 14 previously known and eight novel mutations, namely 3986-3987delC, 876-6del4, 1792InsA, L69H, S158N, Q493L, I530L and E1329Q. The frequency of delta F508 was found to be 27%. Absolute linkage between delta F508 and the KM.19-GATT-TUB9-M470V-T854T haplotype (2-2-1-1-1) predicts a relatively recent appearance of delta F508 in Indian CF patients. Low frequency of delta F508 mutation and detection of eight novel and thirteen rare mutations reflect a heterogeneous spectrum of mutations in Indian CF patients. Failure to detect mutations in 34% of alleles indicates the possible presence of gross deletions involving one or more exons or may indicate the location of the molecular defects in either the noncoding parts of the gene or in the promoter region, which warrants analysis of those regions.

Intermittent Pringle manoeuvre is not associated with adverse long-term prognosis after resection for colorectal liver metastases

BACKGROUND

Intermittent clamping of the porta hepatis, or the intermittent Pringle manoeuvre (IPM), is often used to control inflow during parenchymal liver transection. The aim of this study was to determine whether IPM is associated with an adverse long-term outcome after liver resection for colorectal liver metastasis (CRLM).

METHODS

All patients undergoing resection for CRLM in 1993-2006, for whom data on IPM were recorded, were included in the study. A total of 563 patients was available for analysis.

RESULTS

IPM was performed in 289 (51.3 per cent) of the patients. The duration of IPM ranged from 2 to 104 (median 22) min. There were no differences in clinicopathological features or postoperative morbidity between patients who had an IPM and those who did not. The median survival of patients undergoing IPM was 55.7 months compared with 48.9 months in those not having an IPM (P = 0.406). There was no difference in median disease-free survival between the two groups (22.1 versus 19.9 months respectively; P = 0.199).

CONCLUSION

IPM is not associated with an adverse long-term prognosis in patients undergoing liver resection for CRLM.

Evaluation of the usefulness of phage amplification technology in the diagnosis of patients with paucibacillary tuberculosis

The present study was undertaken to assess the performance of the Fast Plaque TB(TM) (FPTB) test in the diagnostically difficult group of paucibacillary tuberculosis (TB) and to compare its results with the conventional bacteriological methods. The study was conducted on a total of 139 patients, who were negative for TB in sputum-smear examination. Bronchoalveolar lavage (BAL) or pleural biopsy specimens collected from these patients were subjected to smear examination, LJ culture and FPTB test. The smear, culture and the FPTB positivity rates were compared between patients with pulmonary and pleuro-pulmonary involvement. The FPTB test was found to register an overall sensitivity of 58.8% and specificity of 97.9%. The positive and negative predictive values of the test were 98.1 and 56.5, respectively. Among patients with paucibacillary TB, on head-to-head comparison, we found that the sensitivity and specificity values of the FPTB test were marginally better than smear-microscopy and inferior to culture on LJ media.

Successful liver retransplantation for recurrent hepatopulmonary syndrome

HPS is defined as arterial hypoxemia because of pulmonary vasodilation as a result of cirrhotic or non-cirrhotic portal hypertension. This report describes a teenager with HPS because of primary sclerosing cholangitis/autoimmune hepatitis overlap syndrome requiring OLT. HPS resolved completely within three months of OLT, but recurred again at 12 months post-OLT following liver dysfunction secondary to a biliary stricture. She underwent a second OLT successfully and remains well two yr and three months post-second OLT. Recurrent HPS after OLT may occur because of graft dysfunction and as this novel case illustrates, retransplantation may lead to a successful outcome.

Membrane fluidity and lipid composition in clinical isolates of Candida albicans isolated from AIDS/HIV patients

In this study, we describe the membrane lipid composition of eight clinical isolates (azole resistant and sensitive strains) of Candida albicans isolated from AIDS/ HIV patients. Interestingly, fluorescence polarization measurements of the clinical isolates displayed enhanced membrane fluidity in fluconazole resistant strains as compared to the sensitive ones. The increase in fluidity was reflected in the change of membrane order, which was considerably decreased (decrease in fluorescence polarization "p" value denotes higher membrane fluidity) in the resistant strains. The ergosterol content in azole susceptible isolates was greater, almost twice as compared to the resistant isolates. However, no significant alteration was observed in phospholipid and fatty acid composition of these isolates. Labeling experiments with fluorescamine dye revealed that the percentage of phosphatidylethanolamine exposed to the membrane's outer leaflet was higher in the resistant strains as compared to the sensitive strains, indicating increased floppase activity of the two major ABC drug efflux pumps, CDR1 and CDR2 possibly due to their overexpression in resistant strains. The results of the present study suggest that changes in the status of membrane lipid phase especially the ergosterol content and increased activity of drug efflux pumps by overexpression ofABC transporters, CDR1 and CDR2 might contribute to fluconazole resistance in C. albicans isolated from AIDS/HIV patients.

Individual and Domain Adaptation in Sentence Planning for Dialogue

One of the biggest challenges in the development and deployment of spoken dialogue systems is the design of the spoken language generation module. This challenge arises from the need for the generator to adapt to many features of the dialogue domain, user population, and dialogue context. A promising approach is trainable generation, which uses general-purpose linguistic knowledge that is automatically adapted to the features of interest, such as the application domain, individual user, or user group. In this paper we present and evaluate a trainable sentence planner for providing restaurant information in the MATCH dialogue system. We show that trainable sentence planning can produce complex information presentations whose quality is comparable to the output of a template-based generator tuned to this domain. We also show that our method easily supports adapting the sentence planner to individuals, and that the individualized sentence planners generally perform better than models trained and tested on a population of individuals. Previous work has documented and utilized individual preferences for content selection, but to our knowledge, these results provide the first demonstration of individual preferences for sentence planning operations, affecting the content order, discourse structure and sentence structure of system responses. Finally, we evaluate the contribution of different feature sets, and show that, in our application, n-gram features often do as well as features based on higher-level linguistic representations.

Anti-atherogenic effects of seabuckthorn (Hippophaea rhamnoides) seed oil

Seabuckthorn (SBT) seed oil is a rich source of unsaturated fatty acids, phytosterols, carotenoids and flavonoids, which are known to have significant anti-atherogenic and cardioprotective activity. The anti-atherogenic activity of supercritical CO(2) extracted SBT seed oil was evaluated in white albino rabbits fed on high cholesterol diet for 60 days. The study was performed on 20 male healthy rabbits divided into four groups of 5 animals each. Group I - control, group II - SBT seed oil, group III - cholesterol (1%) for 60 days, group IV - cholesterol+SBT seed oil. After 30 days of high cholesterol diet, group IV rabbits received 1 ml of SBT seed oil daily for 30 days. Blood total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C) and triglyceride (TG) levels were measured before and after the administration of SBT seed oil. The vasorelaxant activity of the seed oil was studied in vitro using aortic ring model technique and changes in isometric force were recorded using a polygraphic recording system. Accumulation of cholesterol in the aorta was studied using Sudan-IV staining technique. SBT seed oil feeding to normal rabbits for 18 days caused a significant decline in plasma cholesterol, LDL-C, atherogenic index (AI) and LDL/HDL ratio. The HDL-C levels, HDL-C/TC ratio (HTR) and vasorelaxant activity of the aorta were significantly increased. In cholesterol-fed animals the TC, TG, LDL-C and AI were significantly increased and showed a decline following seed oil administration. The increase in HDL-C was more marked in seed oil treated hypercholesterolemic animals. The acetylcholine-induced vasorelaxant activity was significantly decreased in cholesterol-fed animals and could be restored to that of normal values by seed oil administration. These observations suggest that supercritical CO(2) extracted SBT seed oil has significant anti-atherogenic and cardioprotective activity.

Upper gastrointestinal bleeding and the changing use of COX-2 non-steroidal anti-inflammatory drugs and low-dose aspirin

BACKGROUND

Rofecoxib was withdrawn in 2004.

AIM

To assess the incidence of upper gastrointestinal bleeding in the context of the changing use of cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs and low-dose aspirin.

METHODS

We examined the characteristics of patients developing upper gastrointestinal bleeding in a defined population in south-west Scotland. The primary comparisons were made between two calendar years, preceding and following the withdrawal of rofecoxib.

RESULTS

The overall incidence of upper gastrointestinal bleeding rose from 98.7 in 2002 to 143 per 10(5) of the population per annum in 2005 (chi(2) = 21.1; P < 0.001). The rise in the incidence was associated with using low-dose aspirin, from 26.6 to 38.4 per 10(5) (chi(2) = 5.4; P = 0.02), other antithrombotic drugs, from 12.1 to 30.2 per 10(5) (chi(2) = 19.6; P < 0.001), and excess alcohol, from 23.5 to 36.4 per 10(5) (chi(2) = 7.1; P = 0.008), but insignificantly with using non-steroidal anti-inflammatory drugs, from 13.3 to 16.1 per 10(5) (chi(2) = 0.64; P = 0.4). After adjustment for the concomitant use of these drugs, there was no significant trend in the incidence of upper gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs over the period of 1996-2005.

CONCLUSION

The rise in the incidence of upper gastrointestinal bleeding was weakly related to the change in use of non-steroidal anti-inflammatory drugs. Instead, it probably reflected the increasing use of low-dose aspirin, other antithrombotic drugs and alcohol.

Current knowledge on the distribution of arsenic in groundwater in five states of India

Testing of groundwater used for drinking for arsenic has been undertaken more widely by state governments in several states of India in recent years with the support of UNICEF. Available data for five states are collated in this paper and this provides the most up-to-date picture of areas known to be affected by arsenic in groundwater in the Indian portion of the Ganges-Brahmaputra river basin. In West Bengal, water from 132,262 government installed handpumps in 8 districts has been tested and overall 25.5% of samples were found to contain arsenic at concentrations greater than 50 microgL(-1) and 57.9% at concentrations greater than 10 microgL(-1). On the banks of the Brahmaputra in Assam, to date, samples from 5,729 government handpump sources in 22 districts have been tested for arsenic. Overall, samples from 6.3% of sources were found to contain arsenic at concentrations greater than 50 microgL(-1) and 26.1% at concentrations greater than 10 microgL(-1). In Bihar, on the River Ganges upstream of West Bengal, 66,623 sources from 11 districts have been tested and water samples from 10.8% of sources were found to contain arsenic at concentrations greater than 50 microgL(-1) and 28.9% at concentrations greater than 10 microgL(-1). Upstream of Bihar in Uttar Pradesh, home of the Taj Mahal, to date water samples from 20,126 government-installed handpump sources have been tested. As a result 2.4% of the samples tested were found to contain arsenic at concentrations greater than 50 microgL(-1) and 21.5% at concentrations greater than 10 microgL(-1). Finally in one district of Jharkhand, lying on the Ganges alluvial plain between Bihar and West Bengal, 9,007 sources have been tested and water samples from 3.7% of sources were found to contain arsenic at concentrations greater than 50 microgL(-1) and 7.5% at concentrations greater than 10 microgL(-1). State governments have adopted different sampling strategies and these are described in this paper. Testing is ongoing in several states and the complete picture is yet to emerge in some areas.

Successful outcome after a technically challenging liver transplant during pregnancy

Little is known about the implications of liver transplantation (OLT) during pregnancy. We report the case of a 26-year-old woman with cryptogenic familial biliary cirrhosis that decompensated rapidly. OLT was performed using the donor iliac vein for a retrogastric portal vein conduit to the superior mesenteric vein and the donor iliac artery for an infrarenal aortic conduit. During the latter anastomosis, a viable fetus was noticed. Both donor and recipient were cytomegalovirus positive. Postoperative ultrasound revealed a 13.5-week-old viable fetus. The patient received tacrolimus, azathioprine, and prednisolone. The pregnancy progressed normally with the vaginal delivery of a healthy male infant after 36 weeks gestation. Nineteen months later, both the mother and child were well. This case demonstrated that even technically difficult OLT during pregnancy can have a successful outcome, raising the question of whether transplant patients of childbearing age should be routinely tested for pregnancy.

Identification of Molecular Marker and Aggressiveness for Different Groups of Bipolaris sorokiniana Isolates Causing Spot Blotch Disease in Wheat (Triticum aestivum L.)

One hundred fifty-five isolates of Bipolaris sorokiniana of wheat were studied for their morphopathological characterization. These isolates were grouped in five categories--black, brown/dull black, gray cottony growth, dull white/greenish black, and white--on the basis of their growth pattern. The frequency of the black suppressed type was maximum (45.63%), whereas the white isolate displayed lowest frequency (6.96%) in the natural population. Twenty RAPD (random amplified polymorphic DNA) primers were used to observe the variability among the identified groups of B. sorokininana. From each group, eight random isolates were investigated. A total of 143 bands were amplified, out of which 107 (74.83%) were polymorphic and 36 (25.17%) were monomorphic. On an average, the total numbers of bands generated per primer were 7.15, of which 5.35 and 1.80 were polymorphic and monomorphic, respectively. Dendrograms based on molecular polymorphism unveiled a considerable amount of diversity among the isolates. Specific DNA bands were identified for selected isolates. The distinct markers appeared to be potential enough to be employed as genetic fingerprints for future strain identification and classification. The study indicated that the RAPD primers provide an easy, rapid, and simple technique for the preliminary assessment of genetic diversity among the fungal isolates.

The role of non-corticosteroid related factors in osteonecrosis (ON) in systemic lupus erythematosus: a nested case-control study of inception patients

Several factors have been associated with the development of osteonecrosis (ON) in SLE but corticosteroid (CS) therapy has been the most consistent association. We sought to determine factors that predisposed to, or protected from, the development of ON in lupus patients when cumulative oral corticosteroid doses were matched between cases and controls, thereby removing presence of corticosteroid therapy and cumulative dose as risk factors. A nested case-control study of an inception cohort of SLE patients was used to determine the clinical, laboratory and therapeutic differences between patients who developed their first ON event and patients who did not develop ON, having matched these groups for their cumulative oral corticosteroid doses. Of the 570 patients seen within the first year after diagnosis 65 (11.4%) developed ON. None of the variables examined were found to confer additional ON risk in multivariate analysis. It appears that the major factor associated with the development of ON is corticosteroid therapy. Factors which may protect a majority of patients on corticosteroids from developing ON remain to be elucidated.

Rifampicin induced thrombocytopenia

Thrombocytopenia is an uncommon but potentially life threatening complication of certain anti-tubercular drugs and is characterized by rapid destruction of platelets whenever an offending drug is taken by a susceptible person. Here is a case report of Rifampicin induced Thrombocytopenia. This case is being reported for purpose of its rare occurrence and documentation.

The influence of invasive growth pattern and microvessel density on prognosis in colorectal cancer and colorectal liver metastases

The nature of the invasive growth pattern and microvessel density (MVD) have been suggested to be predictors of prognosis in primary colorectal cancer (CRC) and colorectal liver metastases. The purpose of the present study was to determine whether these two histological features were interrelated and to assess their relative influence on disease recurrence and survival following surgical resection. Archival tissue was retrieved from 55 patients who had undergone surgical resection for primary CRC and matching liver metastases. The nature of the invasive margin was determined by haematoxylin and eosin (H&E) histochemistry. Microvessel density was visualised using immunohistochemical detection of CD31 antigen and quantified using image capture computer software. Clinical details and outcome data were retrieved by case note review and collated with invasive margin and MVD data in a statistical database. Primary CRCs with a pushing margin tended to form capsulated liver metastases (P<0.001) and had a significantly better disease-free survival than the infiltrative margin tumours (log rank P=0.01). Primary cancers with a high MVD tended to form high MVD liver metastases (P=0.007). Microvessel density was a significant predictor of disease recurrence in primary CRCs (P=0.006), but not liver metastases. These results suggest that primary CRCs and their liver metastases show common histological features. This may reflect common mechanisms underlying the tumour–host interaction.

Effect of DC/mDC iontophoresis and terpenes on transdermal permeation of methotrexate: In vitro study

The systemic toxicity caused by methotrexate limits its use and transdermal delivery would be a possible alternative. Transdermal permeation of methotrexate loaded into polyacrylamide-based hydrogel patch, across mice skin was studied in vitro after pretreatment with terpenes and ethanol, alone or in combination with iontophoresis (DC/mDC). Polyacrylamide patches gave the maximum flux as compared to the copolymers of acrylamide and acrylic acid. Of the terpenes used, pure menthol showed maximum enhancement (38%), whereas pure limonene elicited a minimum of 9.9% enhancement. Binary combination of menthol and ethanol increased the permeation to 54.9%, which was further enhanced to 93.69% and 117% when used in combination with DC and square wave (mDC) iontophoresis, respectively. ATR-FTIR of the stratum corneum treated with terpenes showed a split in the asymmetric C-H stretching vibrations along with decrease in peak heights and areas of asymmetric, symmetric C-H stretching, C=O stretching and amide bands. A split in amide II band was observed with iontophoresis. ATR-FTIR studies suggest conformational changes in the lipid-protein domains thereby increasing permeation. Histopathological studies on treated skin samples, gave an insight about the anatomical changes brought by the application of various enhancers. Binary mixture of menthol and ethanol in combination with square wave gave best results.

Prevention and control of proliferative vitreoretinopathy: primary retinal detachment surgery using silicone oil as a planned two-stage procedure in high-risk cases

AIMS

For rhegmatogenous retinal detachment, reattachment with a single procedure is associated with better visual outcomes. In the past, silicone oil has been used mostly as a last resort following failed primary surgery. This study evaluates a novel approach to patients at high risk of primary failure, using silicone tamponade as the primary stage of a planned two-stage procedure.

METHODS

We report a series of 140 eyes that underwent primary surgery for rhegmatogenous retinal detachment. Patients at higher risk of surgical failure (eg giant retinal tear, inability to posture, poor view, uncertainty of location of primary break, primary proliferative vitreoretinopathy (PVR), multiple tears with rolled posterior edges, retinoschisis/detachment, staphyloma with macular hole) were managed by a planned staged procedure using primary silicone oil tamponade. This was followed by silicone removal at a later date.

RESULTS

Fifty-four eyes underwent scleral buckling alone, with primary success in 52/54 (96%). Fifty-three eyes underwent vitrectomy and gas, achieving primary success in 50/53 (94%). Thirty-three eyes were classified high risk and managed with primary silicone. Silicone was safely removed in 22/25. In eight eyes, silicone was retained without attempt at removal. In total, primary retinal reattachment was achieved in 128 of 140 eyes (91.4%). Of these, 124 (97%) did not require long-term tamponade. Only four eyes (2.9%) developed PVR.

DISCUSSION

A planned two-stage approach to highrisk cases of retinal detachment using primary silicone oil tamponade followed by silicone removal can achieve a high primary reattachment rate with less than 3% incidence of PVR.

Effect of inclusion of tree leaves in feed on nutrient utilization and rumen fermentation in sheep

The effect of inclusion of tree leaves in mustard (Brassica campestris) straw (MS) based complete feed blocks (CFB) on nutrient utilization and rumen fermentation was studied in adult male sheep. Four types of CFB diets (Roughage:Concentrate:Molasses, 70:25:5) were prepared. The compaction process increased bulk density (g/cm(3)) of MSB, MSNL, MSSL and MSAL by 2.9, 1.79, 2.40 and 2.26 times, respectively. The dry matter intake (g/day) was higher (P<0.05) in MSSL and MSAL than in MSB. Digestibility coefficients of crude protein and hemicellulose increased (P<0.05) due to inclusion of tree leaves, while digestibility of dry matter and organic matter showed small improvement. However, inclusion of tree leaves did not affect digestibility of neutral detergent fibre, cellulose and energy. The concentration of total volatile fatty acids in rumen was significantly higher in MSAL than in MSB or MSSL. Blood bio-chemical parameters were within the normal physiological range in all the groups.