Audit of care of patients with congenital adrenal hyperplasia due to 21-Hydroxylase deficiency in a referral hospital in South India

We carried out an audit of management of patients with 21-Hydroxylase deficiency CAH who presented to the Department of Endocrinology OPD from 1999 till 2004 and had a minimum follow up of 6 months. Of the 30 patients analysed 24 were girls and 6 were boys. The majority belonged to the Christian community. One third had a history of consanguinity or family history of similar illness. Sex assignment was appropriate in most. Karyotyping was done in half. Half the patients had adequate follow up and 17 OHP measurements. Only 7 out of 30 children had normal height for age. Bone age was done in 16 patients only. Most were on hydrocortisone. The average age of genital surgery was 31 months.

Real-time quantitative PCR for Marek's disease vaccine virus in feather samples: applications and opportunities

Marek's disease, an economically-important lymphoid neoplasm of chickens, is controlled by vaccination with CVI988 strain of Marek's disease herpesvirus. Sub-optimal vaccinal protection can have multiple causes. Accurate quantification of CVI988 in vaccinated chickens will assist in understanding the causes of these vaccine breaks. We developed, optimised and validated a real-time PCR assay for quantification of CVI988 vaccine virus (in terms of CVI988 genomes per 10,000 cells) in the feather tips, a rich source of viral DNA which can easily be sampled in a non-invasive manner. CVI988 load in feathers was predictive of CVI988 load in spleen, so is anticipated to be a good predictor of protection. The optimal age of chicks for feather collection is between two to five weeks, and feathers are preferentially taken from the axillary tract. This PCR test is now used to monitor vaccine virus levels in commercial chicks. For each flock under test, fifty birds are feather sampled for q-PCR. We describe how the feather CVI988 genome profile can show the flock's response to vaccination, and the likelihood of vaccine breaks. Furthermore, the q-PCR test can be applied to researching optimal timing and vaccine delivery routes, and optimal vaccination regimes for different breeds of chick.

Extensive chronic graft-versus-host disease of skin successfully treated with thalidomide

Thirty years female underwent allogenic peripheral blood stem cell transplantation for chronic myeloid leukaemia--chronic phase. She developed grade II acute skin graft-versus-host disease (GVHD) which was treated with cyclosporine and a short course of steroids. She developed extensive chronic GVHD of the skin and liver three hundred days post-transplant. She was managed with the standard immunosuppressants with partial response of liver dysfunction but no response of skin lesions. She showed a good response to therapy with resolution of skin lesions after treatment with thalidomide.

Successful control of Marek's disease by vaccination

Marek's disease (MD) is a neoplastic disease of poultry caused by the highly contagious Marek's disease virus (MDV). Vaccination with live attenuated vaccines forms the cornerstone of the current MD control programmes. The widespread use of the vaccines in the last 30 years has significantly reduced the losses from MD. Despite the huge success of the vaccination policy, the continuing trend in virulence increase of field strains of MDV has forced the introduction of new generations of vaccines to keep up with the creeping virulence increase of MDV. In these circumstances, it is very important to undertake research to develop more sustainable strategies of control. Development of new recombinant DNA technologies such as the use of bacterial artificial chromosomes (BAC) offers the possibility of developing molecularly-defined vaccines. In addition, the availability of the whole chicken genome sequence allows the opportunity of exploiting genetic resistance against MD as another sustainable strategy.

Gangliogliomas: A report of five cases

Gangliogliomas are rare tumors of the Central Nervous System. Five gangliogliomas were diagnosed out of 1560 brain tumours surgically resected out in a period of 5 years accounting for 0. 32%. We have tried to discuss in detail the pathological features of these tumours and have mentioned the clinical and radiological features associated with them. All the slides, tissue blocks and pathology reports of the surgical specimens of gangliglioma were reviewed and the clinical and radiological data reviewed. The ages of the patients ranged from 7-65 years with 4 males and 1 female. The tumors were located in the lateral ventricle (a rare site), temporal, parietal and the frontal lobes with duration of seizures varying from 1-9 years. The tumors were diagnosed by the presence of a dual population of neoplastic ganglionic and glial components. The glial components consisted of pilocytic astrocytes (l case), fibrillary astrocytes (2 cases), oligodendrocytes (1 case) and anaplastic astrocytes and oligodendrocytes (1 case). There was one-grade I GG, three-Grade II GGs and one-grade III GG. Astrocytes were the commonest glial component of GGs, either pilocytic or fibrillary. Oligodendrocytes as the glial component of GGs was seen in 2 cases one of which was anaplastic and this is a rare finding.

Cord blood stem cell banking and transplantation

Stem cells have the ability to divide for indefinite periods in culture and to give rise to specialized cells. Cord blood as a source of hematopoietic stem cells (HSC) has several advantages as it is easily available, involves non-invasive collection procedure and is better tolerated across the HLA barrier. Since the first cord blood transplant in 1988, over 2500 cord blood HSC transplants have been done world wide. Since then, the advantages of cord blood as a source of hematopietic stem cells for transplantation have become clear. Firstly, the proliferative capacity of HSC in cord blood is superior to that of cells in bone marrow or blood from adults. A 100 ml unit of cord blood contains 1/10th the number of nucleated cells and progenitor cells (CD34+ cells) present in 1000 ml of bone marrow, but because they proliferate rapidly, the stem cell in a single unit of cord blood can reconstitute the entire haematopoietic system. Secondly, the use of cord blood reduces the risk of graft vs host disease. Cord Blood Stem Cell banks have been established in Europe and United States to supply HSC for related and unrelated donors. Currently, more than 65,000 units are available and more than 2500 patients have received transplants of cord blood. Results in children have clearly shown that the number of nucleated cells in the infused cord blood influences the speed of recovery of neutrophils and platelets after myeloablative chemotherapy. The optimal dose is about 2 x 10(7) nucleated cells/kg of body weight. The present study was carried out for collection, separation, enumeration and cryopreservation of cord blood HSC and establishing a Cord Blood HSC Bank. 172 samples of cord blood HSC were collected after delivery of infant prior to expulsion of placenta. The average cord blood volume collected was 101.20 ml. Mononuclear cell count ranged from 7.36 to 25.6 x 10(7)/ml. Viability count of mononuclear cells was 98.1%. After 1 year of cryopreservation, the viability count on revival was over 82.1%. Related cord blood stem cell transplantation was carried out in three cases at Army Hospital (R&R), Delhi Cantt.

Novel pyridine-catalyzed reaction of dimethyl acetylenedicarboxylate with aldehydes: formal [2 + 2] cycloaddition leading to 2-oxo-3-benzylidinesuccinates

[reaction: see text]. The 1,4-zwitterionic intermediate generated from pyridine and DMAD adds to aldehydes in a formal [2 + 2] manner, resulting in the facile synthesis of 2-oxo-3-benzylidinesuccinates.

Oxidative cyclisation of cinnamyl ethers mediated by CAN: a stereoselective synthesis of 3,4-trans disubstituted tetrahydrofuran derivatives

The oxidative cyclisation of cinnamyl ethers mediated by cerium(IV) ammonium nitrate results in the stereospecific formation of 3,4-trans disubstituted tetrahydrofuran derivatives in moderate to good yields.

Discovery of a nuclease-resistant, non-natural dinucleotide that inhibits HIV-1 integrase

Integration of HIV viral DNA into human chromosomal DNA catalyzed by HIV integrase is essential for the replication of HIV. Discovery of novel inhibitors of HIV integrase is of considerable significance in approaches to the development of therapeutic agents against AIDS. We have synthesized a new dinucleotide 1 with an internucleotide phosphate bond that is unusually resistant to exonucleases. This compound exhibits potent anti-HIV-1 integrase activity.

Discrepancy between claimed field flux density of some commercially available magnets and actual gaussmeter measurements

CONTEXT

Magnets are widely used by the public in medical applications.

OBJECTIVES

To determine whether the field flux density, a measurement of magnetic dosage, provided by over-the-counter magnet manufacturers is accurate.

DESIGN

Five magnets were tested for field flux density, and measurements were compared with information provided by manufacturers.

RESULTS

Magnets studied showed actual field flux density measurements that were significantly lower than the values claimed by suppliers.

CONCLUSIONS

Over-the-counter magnet suppliers are not providing reliable information; therefore, clinical replication of published reports is difficult.

Changing roles of grass-root level health workers in Kerala, India

OBJECTIVE

Multipurpose health workers (MPWs) are envisioned as key personnel in the delivery of primary health care. We evaluated their role and participation in implementing different national health programmes in Kerala, INDIA:

DESIGN

Cross-sectional, community-based survey.

PARTICIPANTS

We selected three out of the 14 districts in KERALA: Three-hundred and twenty-six MPWs (95 male and 231 female) from 44 randomly selected primary health centres from the three districts were questioned using a structured pre-tested questionnaire that sought information regarding the provision of health services by the MPWs to eligible beneficiaries in the community. We randomly selected 90 subcentres (30 from each district) and 750 households using a cluster sampling technique, and conducted household surveys to compare the actual delivery of services at the doorstep with that reported by the MPWS: Work sampling of MPWs was also performed to examine the fieldwork time spent by them on implementing individual national health programmes. These data were supplemented with focus group discussions and personal interviews of MPWs and household members.

RESULTS

MPWs consistently 'over-reported' their performance when self-reported information was compared with that obtained from household surveys. Male MPWs concentrated on the National Malaria Eradication Programme and health education while female workers focused on the family welfare and immunization programmes. Key national health programmes (such as for tuberculosis and acute respiratory infection) were neglected by all MPWS: MPWs were aware of health problems of the elderly, but were not adequately trained nor officially expected to deliver any services in these fields.

CONCLUSIONS

Grass-root level workers apportion more time to select national health programmes to the detriment of other health programmes, thereby negating their multipurpose role. Our study emphasizes the need for interventions to derive 'multipurpose benefits' from the MPWS:

A new procedure for the phosphorylation of nucleosides: application to the discovery of inhibitors of HIV integrase

A new phosphorylating agent for nucleosides, 2-O-(4,4'-dimethoxytrityl) ethylsulfonylethan-2'-yl-phosphate (1), has been developed by us. In the many examples studied by us, phosphorylation yields were found to be very high (about 90%). The procedure appears to be remarkably general and can be utilized for the phosphorylation of many biomolecules. Successful application of this phosphorylation method has contributed to the discovery of inhibitors of HIV integrase in our laboratory.

Isonucleosides incorporating universal bases

Enantiomeric isodideoxynucleosides of the (S,S) and (R,R) families with the universal base, imidazole-4-carboxamide as the nucleobase, were synthesized as biological mimics of anti-HIV active D- and L-related isodideo-xyadenosines. In vitro anti-HIV evaluation in CEM cells of these target compounds showed that they were inactive. Further antiviral studies are in progress.

Bilateral paravertebral block: a satisfactory alternative for labour analgesia

PURPOSE

To describe a new technique of paravertebral block for labour analgesia and to report the successful use of bilateral paravertebral block in four parturients with contraindications to conventional labour epidural analgesia.

CLINICAL FEATURES

Four parturients with contraindications to lumbar epidural analgesia, who were seen either in consultation prenatally or after requesting analgesia when in labour, consented to paravertebral blocks for the management of first stage of labour pain. Bilateral paravertebral blocks were performed at T10-L1 level, initially blocking all four levels with 4 ml bupivacaine 0.5% with epinephrine 1:200000 and then reducing the number of levels blocked to two and finally one. With the entry point 2 cm lateral to the inferior edge of the T11 spinous process, a 22G spinal needle was advanced perpendicular to all planes until contact was made with the transverse/superior articular process of T12, at a depth of 3-5 cm. The needle was then walked superiorly (T11) and inferiorly (T12 nerve root) off the transverse/articular process and advanced 1.5 cm into the paravertebral space. All four patients had relief of pain such that they were "comfortable" and able to cope with labour although they continued to experience deep pelvic and rectal pain. The patients tolerated the initiation of the blocks well, remained hemodynamically stable, and did not suffer any adverse effects.

CONCLUSION

Bilateral paravertebral block provides adequate analgesia for the first stage of labour and could be an alternative analgesic technique for some parturients with contraindications to conventional labour epidurals.