The psuedo-Chediak-Higashi anomaly: an unusual staining pattern in an Indian child with acute myeloid leukemia

The authors describe the psuedo-Chediak-Higashi anomaly in a 12-year-old boy with acute myeloid leukemia (AML-M2). There were large purple granules in the blasts, promyelocytes, and myelocytes. Instead of the previously described patterns, the authors observed a unique rim pattern staining of the granules in both the May-Grunwald-Giemsa and the myeloperoxidase stains. Moreover, many of the granules had central vacuoles with strong myeloperoxidase positivity at the periphery. The bone marrow had a much higher positivity for these mega-granules as compared to the peripheral blood. On remission, these granules were no longer seen. To the best of the authors' knowledge, this pattern of staining has not been previously reported in the literature.

Susceptibility of Phlebotomus argentipes against DDT in endemic Districts of North Bihar, India

Susceptibility status of Indian kala-azar vector Phlebotomus argentipes after DDT spray from endemic areas of Muzaffarpur and Vaishali district and unsprayed non-endemic area of Patna district, Bihar, India were compared. Higher Lc50 viz. 2.6% and 3.2% and LT50, values 51.0 and 69.0 minutes to 4% DDT were observed for P. argentipes of Muzaffarpur and Vaishali district, whereas P. argentipes of Patna district was 100% susceptible to same concentration, indicating increased tolerance in P. argentipes. It is concluded DDT resistant P. argentipes, particularly in endemic zone growing. The possible explanation could be long-term insecticidal pressure.

The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer

OBJECTIVE

To evaluate lower urinary tract symptoms (LUTS) and the symptom-associated quality of life (QoL) after radical prostatectomy.

PATIENTS AND METHODS

We carried out a prospective study (January 1999 to March 2001) of 50 consecutive men initially assessed in the nurse-led prostate assessment clinic for their LUTS and subsequently diagnosed to have localized prostate cancer. They had a radical retropubic prostatectomy and were assessed before, 3 and 6 months after surgery with a self-administered International Prostate Symptom Score (IPSS) and QoL questionnaires, and measurements of urinary flow rate and postvoid residual urinary (PVR) volumes. Finally, each patient completed a self-administered continence questionnaire at 6 weeks, 3 and 6 months after surgery.

RESULTS

In men with moderate to severe LUTS before surgery there were significant improvements in total IPSS, symptom-associated QoL, mean peak flow rate and PVR (P < 0.05). However, in eight men with mild LUTS, although there was a 33% improvement in the total symptom score, it was not statistically significant. Thirty-eight patients reported complete continence, nine had infrequent stress leaks only on heavy physical activity, and the remaining three used < 2 pads/day for protection before heavy physical activity at 3 months after surgery.

CONCLUSIONS

Radical prostatectomy provides major benefits to men with LUTS besides cancer control. These data are important in counselling patients about the treatment options, especially in view of the current enthusiasm for brachytherapy and conformal radiotherapy, which may worsen LUTS.

Genetic Diversity and Relationships among the Tribes of Meghalaya Compared to Other Indian and Continental Populations

The autosomal AmpFLSTR markers validated and widely used for forensic applications are used in this study to examine the extent of diversity and genetic relationships among nine Meghalaya populations. Altogether, 932 chromosomes from 9 populations were analyzed using 9 tetrameric AmpFLSTR loci. The included populations were all seven subtribes of the Austro-Asiatic Mon-Khmer-speaking Khasi and the neighboring Tibeto-Burman Garo. The Lyngngam, which are linguistically closer to the Khasi but are culturally intermediate between the Khasi and the Garo, are also included in the study. Although most of the microsatellite loci are highly polymorphic in each of these populations, the allele distributions are fairly uniform across the Meghalaya populations, suggesting relative homogeneity among them. Concurrent with this, the coefficient of gene differentiation (G(ST)) is observed to be low (0.026+/-0.002). This is naturally reflected in the lack of clear differentiation and clustering pattern of the Meghalaya tribes based on either geographic proximity or the historical or current affiliations of these tribes. Analysis of molecular variance (AMOVA) suggests no significant population structure. The structure analysis further suggests that, barring War-Khasi and Pnar, no other population shows any semblance of genetic identity. Even the position of the linguistically distinct Garo is not portrayed as separate from the Khasi. However, when comparable data from other Indian, Southeast Asian, and other continental populations were analyzed, the Meghalaya populations formed a compact cluster clearly separated from other populations, suggesting genetic identity of the Meghalaya populations as a whole. These results are concurrent with the hypothesis of a common and recent origin of these Meghalaya populations, whose genetic differentiation is overwhelmed by the homogenizing effect of continuous gene flow.

Clinical spectrum, pitfalls in diagnosis and therapeutic implications in herpes simplex encephalitis

OBJECTIVES

High index of suspicion is mandatory for early diagnosis of Herpes Simplex Encephalitis (HSE), since acyclovir therapy can prevent its mortality and limit morbidity. We report our observations on clinical spectrum, pitfalls in diagnosis and therapeutic aspects in patients of HSE.

METHODS

There were 34 patients of HSE (26 males and eight females) in age range 6 -72 (mean 23.8 +/- 8.9) years. Diagnosis was confirmed by cranial MRI, EEG and PCR in CSF. Acyclovir was given to 24 patients. Carbamazepine and sodium valproate were the antiepileptic drugs used.

RESULTS

Most of the patients were referred either as Japanese encephalitis, cerebral malaria or tubercular meningitis. High fever, seizures, behavioral abnormality and encephalopathy were present in all, either at onset or later. EEG, CSF abnormality and cranial MRI were abnormal in all 34 patients. PCR for Herpes Simplex virus was positive in 65 % cases CT was performed in 10 cases but abnormality was detected only in four. We observed features of Kluver Bucy syndrome in three patients, suffering from HSE. Following complete acyclovir therapy in 24 patients, 12 recovered completely and four partially. There was no improvement in four patients including two patients who had features of Kluver Bucy Syndrome, while four expired. Among the seven patients who refused therapy of acyclovir, five expired, while two remained in unaltered status. Treatment could not be completed in three patients as they expired during therapy.

CONCLUSION

HSE is commonly misdiagnosed. Important factors influencing mortality and morbidity of HSE were; early acyclovir therapy, age, immune status of patient, duration of illness, and consciousness level before initiation of therapy. We conclude that acyclovir should be given to all patients as soon as suspected, while confirmatory investigations are in progress.

Percutaneous vertebroplasty: an experience of 31 procedures

A prospective study of 31 percutaneous vertebroplasty procedures (PVP) in 22 patients treated during January 2000 to December 2001 is presented. PVP was performed using polymethylmethacrylate (PMMA) to treat vertebral collapse due to osteoporosis and vertebral metastasis, to obtain analgesia and spinal stabilization. We analyze the efficacy and complications related to the procedure. PVP is a safe, effective and a daycare surgery. It can be performed under local anesthesia and has minimal and manageable complications.

Na adsorption on the Si111-(7 x 7) surface: from two-dimensional gas to nanocluster array

We have systematically investigated Na adsorption on the Si(111)-(7 x 7) surface at room temperature using scanning tunneling microscopy (STM). Below the critical coverage of 0.08 monolayer, we find intriguing contrast modulation instead of localized Na adsorbates, coupled with streaky noise in the STM images, which is accompanied by monotonic work function drop. Above the critical coverage, Na clusters emerge and form a self-assembled array. Combined with first-principles theoretical simulations, we conclude that the Na atoms on the (7 x 7) surface are, while strongly bound ( approximately 2.2 eV) to the surface, highly mobile in "basins" around the Si rest atoms, forming a two-dimensional gas phase at the initial coverage, and that the cluster at the higher coverage consists of six Na atoms together with three Si adatoms.

2'-(2,3-Dihydroxybenzoyloxy)-7-ketologanin: a novel iridoid glucoside from the leaves of Gentiana kurroo

A new bitter acylated iridoid glucoside, 2'-(2,3-dihydroxybenzoyloxy)-7-ketologanin (1), has been isolated from the leaves of Gentiana kurroo. The structure of the compound was elucidated conclusively by chemical analysis, and extensive 1D and 2D NMR experiments.

Herpes simplex encephalitis: some interesting presentations

Herpes Simplex Encephalitis (HSE) is the most common cause of fatal viral encephalitis. A high index of suspicion is mandatory for early diagnosis and successful therapy to restrict morbidity and mortality. We report 4 patients of HSE, with interesting presentations, viz. brainstem involvement in an immunosuppressed patient, Kluver-Bucy Syndrome-a consequence of untreated HSE, HSE in the postpartum period mistaken as cortical venous thrombosis, and response to inadequate treatment. They demonstrate the wide spectrum of clinical features, pitfalls in diagnosis, and a variable response to therapy in HSE.

Comparison of DNA sequencing, PCR-SSCP and PhaB assays with indirect sensitivity testing for detection of rifampicin resistance in Mycobacterium tuberculosis

SETTING

Tuberculosis Research Centre, Chennai, India.

OBJECTIVE

To rapidly identify multidrug-resistant Mycobacterium tuberculosis using phenotypic and genotypic methods.

DESIGN

Two genotypic assays, DNA sequencing and polymerase chain reaction single strand conformation polymorphism (PCR-SSCP), and one phenotypic assay, phage amplified biological assay (PhaB) were standardised in-house and performed on coded 101 rifampicin-resistant and 100 rifampicin-sensitive M. tuberculosis clinical isolates for the identification of rifampicin resistance.

RESULTS AND CONCLUSION

The results obtained using the three assays were compared with those from the conventional indirect sensitivity test. The sensitivities and specificities of DNA sequencing, PCR-SSCP and PhaB were 97% and 100%, 76% and 100%, and 97% and 84%, respectively. DNA sequencing was found to be more sensitive and specific than the other tests.

Telecardiology for effective healthcare services

Continuous monitoring of the electrocardiogram (ECG) and other signals related to current heart activity are necessary for patients who are suffering from cardiac diseases. This paper deals with the work that has been carried out to transmit ECGs from remote sites. Software has been developed which enables the uploading of ECG data from a patient so that the physician can monitor the state of the patient from a distance and at the same time may consult other experts for a second opinion. Records can only be examined by the authorized physician after proper registration and diagnosis or prescription may be sent back to the referring site. Further consultation with the patient through a 'chat' facility is also possible. The suitability of the system over transport control protocol (TCP), internet protocol (IP), local area network (LAN), wide area network (WAN) and World Wide Web (WWW) has been assessed. The bandwidth, latency, availability, security and ubiquity have also been discussed. A study has also been undertaken in order to make the system compatible with available bandwidths and to find out which one out of a number of available techniques is most efficient for ECG data compression. The results indicate that the scheme is suitable for telecardiology and can form part of an overall telemedicine system in a health care network.

Oxidized cellulose esters: I. Preparation and characterization of oxidized cellulose acetates--a new class of biodegradable polymers

Oxidized cellulose acetates (OCA), with a degree of substitution (DS) value ranging between 1.1 and 2.3 and a free carboxylic acid group content of 20% (w/w), have been prepared by reacting oxidized cellulose (OC, COOH content 20% w/w) with a mixture of acetic acid and acetic anhydride in the presence of sulfuric acid as a catalyst. The DS of OCA, in general, increased with increasing reaction temperature, reaction time, and concentration of acetic anhydride in the reaction mixture. The yield of OCA, in contrast, increased with increasing concentration of acetic anhydride and decreased with increasing reaction time and temperature. The intrinsic viscosity of OCA varied between 0.100 and 0.275, depending on the reaction conditions used during its preparation. In general, an increase in reaction temperature and the use of a prolonged reaction time decreased the intrinsic viscosity of OCA. No correlation was found between DS and intrinsic viscosity of OCA. The apparent pKa of OCA is 3.7-3.9. The new OCA polymers are practically insoluble in water and slowly dissolve in pH 7.4 phosphate buffer solution. They are, however, soluble in a range of organic solvents (e.g. ethyl acetate, acetone, acetone/water, chloroform/methylene chloride, dimethylsulfoxide, dimethylformamide, and/or chloroform/methanol).

In vitro antimalarial activity of metalloporphyrins against Plasmodium falciparum

The in vitro antimalarial activity against Plasmodium falciparum and heme polymerization were evaluated for ten metalloporphyrins: gallium protoporphyrin IX (GaPPIX), sodium salt of gallium protoporphyrin IX, silver protoporphyrin IX, palladium protoporphyrin IX, cobalt protoporphyrin IX, manganese protoporphyrin IX, tin protoporphyrin IX (SnPPIX), chromium protoporphyrin IX, gallium deuteroporphyrin IX (GaDPIX) and gallium hematoporphyrin IX. Metalloporphyrins inhibited parasite growth with 50% inhibitory concentrations (IC(50)) ranging from 15.5 microM to 190 microM. In trophozoite lysate-mediated heme polymerization assays, SnPPIX, GaPPIX and GaDPIX exerted potent inhibitory activity similar to that of artemisinin and chloroquine.

Immunogenicity and reactogenicity of a recombinant hepatitis B vaccine in subjects over age of forty years and response of a booster dose among nonresponders

AIM: The study was initiated to evaluate the reactogenicity and immunogenicity of a recombinant hepatitis B vaccine in age group > 40 years and to study the response of a single booster dose in primary non-responders to the hepatitis B vaccination.

METHODS: A total of 102 volunteers without markers of hepatitis B infection (negative for HBsAg, anti-HBc antibody, HBeAg and anti-HBs antibody) received 20 μg of recombinant HB vaccine intramuscularly at 0, 1, and 6 months. Anti HBs titers were evaluated by a quantitative Elisa kit at 90 and 210 days. A booster dose of 20 μg HB vaccine was given after 6 months of the 3^rd vaccine dose to the 15 non-responders and anti-HBs titers were measured after 1 month.

RESULTS: Seroprotection (anti-HBs GMT³ 10 IU/L) was achieved in 85.3% (87/102) volunteers. The mean GMT titers of the vaccine responders was 136.1 IU/L. Of the seroprotected individuals, there were 32.4% (33/102) hyporesponders (anti-HBs titers < 10-99 mlU/ml) and 52.9% (54/102) were responders (anti-HBs titers > 100 IU/L). All the non-responders (15/15) responded to a single dose of the booster dose of recombinant HB vaccine and their mean anti-HBs antibody titers were more than 100.5 mIU/ml after the booster dose.

CONCLUSION: Recombinant hepatitis B vaccine offers good seroprotection in the age group > 40 years and has a good safety profile. A single booster dose after 6 months in primary non-responders leads to good seroprotective anti-HBs antibody titers. However, larger population based studies are needed to evaluate the role of a booster dose in selected group of non-responders and whether such an approach will be cost effective.

Antithrombin III activity in cerebrovascular accidents

Cerebrovascular accidents are commonly due to occlusive or haemorrhagic lesions. The present prospective study was planned to find out role of antithrombin in possible etiopathological process, which might predispose an individual for stroke.

METHOD

Biological activity of antithrombin III was done by the method as described by Innerfield et al (1976). Immunological estimation of an antithrombin III was done by single radial immunodiffusion by the technique of Mancini et al modified by Fahey and Mckelvey.

RESULTS

The biological and immunological activity of antithrombin III was measured in 98 patient of occlusive and 56 patients of haemorrhagic strokes. Significant depression in biological as well as immunological activity (p<0.001) was observed in occlusive stroke. In haemorrhagic stroke both, biological and immunological activity was increased. In follow up study, there was progressive normalization of both, biological as well as of immunological activity in both group.

CONCLUSION

Decrease of antithrombin III in occlusive and increase in haemorrhagic stroke indicates that these changes have at least an additive role in the pathogenesis of stroke.

IgE binding synthetic peptides of Alt a 1, a major allergen of Alternaria alternata

Alternaria alternata protein, Alt a 1 is a major allergen associated with allergy in atopic patients. Although the molecule binds strongly to IgE antibody from patients, the epitopes involved have not been identified or defined. In the present study, we synthesized overlapping peptides spanning the whole sequence and evaluated their IgE binding with sera from patients with Alternaria-induced allergy. The results identified four IgE binding linear regions. Two of these regions K41-P50 and Y54-K63 showed consistent reactivity with all four patients studied. The specific epitopes involved in the immune response may be of value in the immunodiagnosis and probably also in specific immunotherapy.

Ultrastructural Study of Schwann Cells and Endothelial Cells in the Pathogenesis of Leprous Neuropathy

Peripheral nerve biopsies from 4 borderline tuberculoid (BT) and 4 lepromatous (LL) patients who were on multidrug therapy were investigated by light and electron microscopic studies. The variation of diameters and distribution of myelinated and unmyelinated fibers between BT and LL patients were not significant. This study has shown significant changes in peripheral nerves and endoneural blood vessels. It was revealed that besides Schwann cells (SC), the endothelial cells (EC) of endoneural blood vessels frequently harbor M. leprae. In BT, peripheral nerves in addition to the degenerative changes of SC and presence of perineural and perivascular cuffing by mononuclear cells, the endoneurial blood vessels showed thickening of basement membrane with hypertrophy of EC leading to narrowing or complete occlusion of lumen. On the other hand, peripheral nerves of LL patients were infiltrated with large number of M. leprae shown to be present in the electron transparent zone (ETZ) of the SC. The EC of endoneurial blood vessels were found to be loaded with M. leprae, and this bacillary loaded EC was found to release M. leprae into the lumen through its ruptured membrane.