Varietal differences in accumulation of aflatoxin B1 in Indian rice cultivars

Rice (paddy) seeds are known to be colonised by Aspergillus flavus in the field or under storage conditions and contaminated with aflatoxins which have impact on human and animal health. In this study, we investigated the varietal differences in 30 Indian healthy rice cultivars used for human consumption (15 normal and 15 basmati) for accumulation of aflatoxin B1 (AFB1) after inoculation with aflatoxin-producing A. flavus (DRAf 009). Significant varietal differences in AFB1 accumulation were observed in normal and basmati rice cultivars. Comparatively, the accumulation of AFB1 is higher in normal cultivars, ranging from 3-628 µg/kg, than in basmati cultivars, ranging from 0.2-7.2 µg/kg. The highest accumulation of AFB1 in normal cultivars was observed in PR 106 (628 µg/kg) and the lowest in IR 64 (3 µg/kg). In basmati rice cultivars, the highest accumulation of AFB1 was observed in Ranbir basmati (7.2 µg/kg) and the lowest in Vasumati (0.2 µg/kg). All these cultivars were evaluated for their total phenolic content (TPC) in rice bran using the Folin-Ciocalteau method. The results indicated that the TPC of normal and basmati cultivars was in the range of 1.96-2.45 and 2.13-2.65 mg gallic acid equivalent (mg/g of bran), respectively. This study may be used as a basis to develop A. flavus resistant rice cultivars and proper storage structures to produce aflatoxin-free rice. This is the first report on the evaluation of various rice cultivars for accumulation of AFB1 after inoculation with A. flavus.

Ulnar translocation after excision of a Campanacci grade-3 giant-cell tumour of the distal radius: an effective method of reconstruction

Between June 2005 and March 2008, 14 patients with a Campanacci grade-3 giant-cell tumour of the distal radius were treated by en bloc resection and reconstruction by ulnar translocation with arthrodesis of the wrist. The mean length of radius resected was 7.9 cm (5.5 to 15). All the patients were followed to bony union and 12 were available at a mean follow-up of 26 months (10 to 49). The mean time to union was four months (3 to 7) at the ulnocarpal junction and five months (3 to 8) at the ulnoradial junction. All except one patient had an excellent range of pronation and supination. The remaining patient developed a radio-ulnar synostosis. The mean Musculoskeletal Tumor Society score was 26 (87%, range 20 to 28). Three patients had a soft-tissue recurrence, but with no bony involvement. They underwent a further excision and are currently well and free from disease. Ulnar translocation provides a local vascularised bone graft to reconstruct the defect left after excision of the distal radius for giant cell tumour. It avoids the need for a microvascular procedure while retaining rotation of the forearm and good function of the hand.

Molecular Detection of 16SrXI Group Phytoplasma Associated with Root (Wilt) Disease of Coconut (Cocos nucifera) in India

Coconut palm (Cocos nucifera L.), a versatile tree crop with multifarious uses, is important for the livelihood security of millions of people in India. Root (wilt) disease (RWD) is a major production constraint causing an estimated yield loss of 968 million nuts in southern India. Affected palms show bending of leaflets (flaccidity), foliar yellowing, and marginal necrosis. Phytoplasmas have been observed to be associated with this disease by electron microscopy (EM) and transmission (3) but not characterized. Attempts made in the past decade to detect a phytoplasma associated with RWD through PCR using universal primers had inconsistent results so we designed two primer sets (1F7 [AGTGCTTAACACTGTCCTGCTA]/7R3 [TTGTAGCCCAGATCATAAGGGGCA], 3Fwd [ACCTGCCTTTAAGACGAGGA]/3Rev [AAAGGAGGTGATCCATCCCCACCT]) and seminested primer pair 1F7/7R2 (GACAAGGGTTGCGCTCGTTTT), 3Fwd/5Rev (ACCCCGAGAACGTATTCACCGCGA) from sequencing of a 1.8-kb fragment (GenBank No. FJ794816) amplified by primers P1/P7 from a diseased sample. These new primer pairs were used for the detection of phytoplasma from five symptomatic and five asymptomatic palms from Kasaragod (where disease is not endemic), 14 symptomatic palms from Kayamkulam (endemic area), and 10 palms from disease-free areas (Kidu, Karnataka) using PCR. DNA was extracted from 3 g of spindle leaf (two to three leaflets) midrib tissues using a modified phytoplasma enrichment protocol in which an addition of 5% polyvinylpolypyrrolidone (MW of 40,000) during tissue grinding was essential. PCR was performed for 35 cycles with an annealing temperature of 63°C to avoid nonspecific amplification. A 1.3-kb amplicon was seen in two of the five samples and the positive control sample (sugarcane grassy shoot DNA) using the seminested primer pair 3Fwd/3Rev-3Fwd/5Rev. The amplicons were cloned and sequenced and a representative sequence was deposited in GenBank (GQ850122). With the 1F7/7R3-1F7/7R2 seminested primers, a 493-bp product was obtained from 13 of 14 palms from Kayamkulam and all five diseased palms from Kasaragod. No amplification was seen from healthy palms. A BLAST search showed that the RWD phytoplasma 16S rRNA gene sequence has >96% nt identity with 16SrXI and 16SrXIV group phytoplasmas and 99% identity with sugarcane white leaf phytoplasma (AB052874), On the basis of the identity of the 16Sr RNA gene 3Fwd/5Rev region, RWD phytoplasma belongs to the 16SrXI group. A phylogenetic tree (neighbor-joining method) also revealed clustering of the coconut phytoplasma with the 16SrXI group phytoplasmas and virtual restriction fragment length polymorphism analysis (4) also placed it into group 16SrXI. Other phytoplasmas infecting coconut are found in groups 16SrIV (1) and 16SrXIV (2). Our RWD phytoplasma sequence does not match an earlier reported Kerala (wilt) coconut phytoplasma sequence (AY158660) and the latter sequence does not have similarity with any known phytoplasma sequences in the database. To our knowledge, this is first report of the association of 16SrXI group phytoplasma with the root wilt disease of coconut in India. These findings could be used for the early detection of root wilt disease phytoplasma in breeding materials and to develop a DNA-based diagnostic kit. References: (1) N. A. Harrison et al. Ann. Appl. Biol. 153:85, 2008. (2) N. Nejat et al. Am. J. Appl. Sci. 6:1331, 2009. (3) M. Sasikala et al. Eur. J. Plant Pathol. 94:191, 2005. (4) Y. Zhao et al. Int. J. Syst. Evol. Microbiol. 59:2582, 2007.

Bicycle handlebar hernia with multiple enterotomies: a case report

BACKGROUND

Bicycle handlebar hernias are uncommon form of traumatic abdominal wall hernias (TAWH) resulting from a direct blunt trauma to the anterior abdominal wall.

CASE PRESENTATION

This report describes a 14 year-old boy with no history of previous abdominal hernia, presented in the emergency department with an isolated, tender lump in his right iliac fossa after falling off his bicycle. Contrast Enhanced Computer Tomography (CE-CT) showed intestinal loops protruding through the abdominal wall defect with free air in peritoneum suggesting hollow viscus perforation. He underwent emergency laparotomy through transverse skin incision, which showed mid jejunum mesentery tear and multiple enterotomies. A wedge small bowel resection of enterotomies with primary closure, repair of mesenteric tear followed by a primary repair of the abdominal wall hernia was performed. The patient made an uneventful post-operative recovery.

CONCLUSION

Bicycle handlebar Hernia (BHH) is a type of traumatic abdominal wall hernia caused by a low impact energy direct blunt injury. We describe a case of BHH associated with small bowel injury which was treated with exploratory laparotomy through skin crease traverse incision. This surgical approach allowed an appropriate exploration of all the intrabdominal structures and primary repair of the hernial defect.

Peginterferon alpha-2a (40 kDa) and ribavirin: comparable rates of sustained virological response in sub-sets of older and younger HCV genotype 1 patients

The average age of patients initiating therapy for HCV is increasing, with older patients exhibiting lower responses to therapy than younger patients. Identification of those older patients likely to respond needs to be addressed. Using data from 569 genotype-1 patients enrolled in two phase III studies (NV15801/NV15942) randomized to peginterferon alpha-2a (40 KDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48-weeks, we investigated factors associated with sustained virological response (SVR; undetectable HCV-RNA 24-weeks post-treatment) in patients >50 years. SVR rates among patients <or=50 was greater than those >50 years (52%vs 39%; P = 0.0073). Older patients with a rapid virological response (RVR; undetectable HCV-RNA at treatment week 4) or complete early virological response (cEVR; detectable HCV-RNA at week 4 but HCV-RNA <50 IU/mL at week-12) demonstrated high SVR rates (83% and 61% respectively). Older patients had lower cumulative peginterferon alpha-2a exposure and significantly lower cumulative ribavirin exposure (252 g vs 304 g in younger patients; P < 0.0001). Higher relapse rates were observed in older patients (41%vs 25%; P = 0.0042). Cumulative drug exposure and achievement of RVR or cEVR were significantly predictive of SVR by multiple logistic regression analysis in patients >50 years. Other baseline characteristics predictive of SVR in those >50 years of age were lower baseline HCV-RNA level (P = 0.0067), higher ALT-ratio (P = 0.0113) and absence of cirrhosis (P = 0.0482). Response rates were high among patients >50 years without cirrhosis who maintained adequate drug exposure and those achieving an RVR or cEVR. More frequent dose modifications of ribavirin in those >50 years likely contributed to the observed higher relapse rates.

Development of indices to predict phosphorus release from wetland soils

The U.S. Environmental Protection Agency created the Clean Water Action Plan to develop nutrient criteria for four water body types: lakes and reservoirs, rivers and streams, estuaries, and wetlands. Significant progress has been made in open water systems. However, only areas in and around the Florida Everglades have had numeric nutrient criteria set, due to the complexity, heterogeneity, and limited information available for wetlands. Our objective was to evaluate various soil tests to predict significant P release potential of soil in wetlands. A total of 630 surface soil samples (0-10 cm) were collected for this study from four southeastern states: Florida, Alabama, Georgia, and South Carolina. Soil samples were collected from the center of wetlands, the edge of the wetlands, and from adjacent uplands. The phosphorus saturation ratios (PSR), calculated using P, Fe, and Al molar concentrations from Mehlich 1 (M1-PSR), Mehlich 3 (M3-PSR), and oxalate (Ox-PSR) extractions and the amount of P extracted by different extractants were used to predict P loss potential from a soil. Total phosphorus (TP) concentration in wetland soils, estimated as the 75th percentile of the distribution of least impacted wetland soils as an example, was approximately 550 mg kg(-1). Based on this reference background condition, procedures for obtaining threshold values for P release to the surrounding water bodies were developed and threshold values calculated: M1-P = 24 mg kg(-1), M3-P = 44 mg kg(-1), Ox-PSR = 0.079, M1-PSR = 0.101, and M3-PSR = 0.067.

Multiple fourth ventricular hydatidosis

Hydatid disease caused by ingestion of eggs of the cestode Echinococcus granulosus is endemic in the Middle East, Mediterranean countries, South America, North Africa and Australia.(1) Infratentorial occurrence of hydatid cyst is rare. We present a report of an extremely rare case of multiple exclusive fourth ventricular hydatid cysts, both primary and secondary, and discuss problems with the diagnosis and management of this condition.

Review article: the evaluation of solitary liver masses

BACKGROUND

The increasing use of imaging modalities has led to the detection of more liver masses. The differential diagnosis of a focal liver mass includes a host of benign as well as malignant conditions.

AIM

To provide a comprehensive review on the commonly encountered liver masses, and to help guide an approach to their evaluation and management.

METHODS

Pertinent literature that was identified through PubMed search and senior author's experience formed the basis of this review.

RESULTS

While most incidentally noted liver masses are benign, it may be difficult to differentiate them from those that are malignant. Furthermore, some benign lesions have malignant potential. Certain lesions such as focal nodular hyperplasia, haemangiomas and focal steatosis are often distinctly diagnosed by an imaging modality alone. The less frequently encountered hepatic adenomas are diagnosed radiologically in those with the appropriate clinical background and the absence of radiological features to suggest haemangioma or focal nodular hyperplasia.

CONCLUSIONS

A reasonable approach to the diagnosis, follow-up and management of liver masses is based on a rudimentary knowledge of their presentation, associated clinical and laboratory features, natural history and available treatment options. Most often, the so called 'incidentalomas' are benign and require patient reassurance.

Budd-Chiari syndrome, ascites and shunt malfunction due to hyperosmolar hypernatremia in operated pediatric craniopharyngiomas: a red herring

INTRODUCTION

Postoperative management of sellar and suprasellar lesions in children involves regular evaluation of fluid, electrolyte, and neuroendocrine parameters. On discharge, maintenance of water homeostasis is difficult especially among those with access to only basic primary health care. Complications of a chronic hypernatremic state can lead to severe morbidity and mortality.

CASES

The authors present two cases of craniopharyngioma who developed inferior vena cava thrombosis, Budd-Chiari syndrome, and shunt malfunction postoperatively. Factors which predispose to a hypercoagulable state are evaluated along with measures undertaken to identify and treat the cause of ascites and shunt malfunction.

DISCUSSION

The role of hypernatremia, serum hyperosmolality, and Vasopressin analogs in the pathology are discussed along with imaging and treatment.

Hepatocellular carcinoma in long-term sustained virological responders following antiviral combination therapy for chronic hepatitis C

Antiviral treatment results in a sustained virologic response (SVR) in 50-75% of patients with chronic hepatitis C. Long-term follow up studies have observed ongoing SVR in the overwhelming majority of them. Thus chronic hepatitis C is considered 'cured' if an SVR is achieved. Consequently, it is expected that in sustained virologic responders long-term complications of hepatatic C virus (HCV) related chronic liver disease including hepatocellular carcinoma are eliminated or have a decreased incidence. We report on five patients (three from Austria, two from USA) who developed hepatocellular carcinoma during follow up (3-6 years) after achieving SVR. During follow up and at diagnosis all were HCV-RNA neg. None of the patients had other liver diseases. One patient presented with bilateral adrenal metastasis, the remaining four with large hepatic tumours. Three patients were noncirrhotic at the start of treatment at the time of tumour diagnosis. Successful antiviral treatment in HCV patients does not prevent development of hepatocellular carcinoma even in non-cirrhotic livers. Long-term follow up of patients with SVR is mandatory and should include surveillance for hepatocellular carcinoma.

The response of benthic foraminifera to various pollution sources: a study from Nellore Coast, East Coast of India

A study of benthic foraminiferal species was carried out along Nellore Coast of South India. Analysis of surfacial sediment samples from the study area shows enrichment in heavy metals (Cr, Cu, Pb and Zn). The environment has become so lethal to foraminifera that minimal species number (4-7) can currently preserved in living condition in a depth less than 5-fth contour from coast. Samples from outfalls which receive only agricultural and aquacultural drainage water show heavy metal concentrations slightly higher to natural baseline levels, and yielding, living foraminifera (10-15). The frequent occurrence of deformed and abnormal specimens in Industrial outfalls, comparable to aquacultural and agricultural outlets reveal that (a) benthic foraminifera are more sensitive to industrial wastes containing heavy metals, (b) agricultural and aquacultural wastes do not significantly harm benthic foraminifera, and (c) morphological abnormalities of the foraminiferal tests depend upon the nature of the pollutant.

Quadriceps tendon rupture and periosteal sleeve avulsion fracture of the proximal patella pole in an active adolescent

A unique case of anterior knee pain in an active adolescent is described: a periosteal sleeve avulsion and quadriceps rupture in a young basketball player. The trauma mechanism was without any direct trauma on the knee. A review of overuse-related anterior knee pain in the young and active is presented. A quadriceps rupture with a periosteal sleeve avulsion fracture in an active adolescent is very rare. To our knowledge there are no similar cases described. This article presents a case of a 14-year-old adolescent boy who sustained a quadriceps rupture with a periosteal sleeve avulsion.

Hepatic steatosis in chronic hepatitis C: baseline host and viral characteristics and influence on response to therapy with peginterferon alpha-2a plus ribavirin

Hepatic steatosis is common in hepatitis C virus (HCV)-infected patients and may be associated with the metabolic syndrome. We studied steatosis in patients treated with peginterferonalpha-2a plus ribavirin. Forty-five of 207 patients (22%) had >5% hepatic steatosis at baseline. Significantly more patients with steatosis than without were HCV genotype 3 (51%vs 14%; P < 0.0001) had higher HCV-RNA (P = 0.0045), body weight (P = 0.0176), body mass index (BMI, P = 0.0352) and serum triglycerides (TG) (P = 0.0364), hypertriglyceridaemia (P = 0.0009), elevated blood pressure/history of hypertension (P = 0.0229) and lower cholesterol (P = 0.0009). Significant steatosis predictors were genotype 3 (OR 9.04, 95% CI 3.85-21.21, P < 0.0001), HCV-RNA (OR 2.96, 1.49-5.88, P = 0.0019) and triglycerides (OR 1.06, 1.02-1.11, P = 0.0071). In genotype 3 patients, HCV-RNA was the only significant predictor (OR 11.15, 2.60-47.81, P = 0.0012). In non-genotype 3 patients, hypertriglyceridaemia was the only significant predictor (OR 1.07, 1.02-1.12, P = 0.0041). 134 of 207 patients (65%) achieved an sustained virological response (SVR) with peginterferon alpha-2a plus ribavirin, similar to the overall response rate. In genotype 3 patients with an SVR, steatosis decreased from 48% to 13% (baseline to end-point). No change was seen in the steatosis rate in non-genotype 3 patients with an SVR. This large and comprehensive analysis of a large data base from a multinational trial further adds to the observations that chronic HCV is associated with hepatic steatosis in approximately a fifth of patients. Further, features of the metabolic syndrome are associated with hepatic steatosis in most of these patients. Steatosis is significantly more common in genotype 3 compared with other genotypes, and in these patients, an SVR is associated with steatosis clearance.

Phosphorus sorbing materials: sorption dynamics and physicochemical characteristics

The effectiveness of various management practices to reduce phosphorus (P) loss from soil to water can potentially be improved by using by-product materials that have the capacity to sorb phosphorus. This study evaluated the P sorption and desorption potential, and the physicochemical characteristics of various phosphorus sorbing materials. Twelve materials were selected and P sorption potentials ranged between 66 and 990 mg kg(-1). Iron, and calcium drinking water treatment residuals (DWTRs), a magnesium fertilizer by-product, aluminum, and humate materials all removed substantial amounts of P from solution and desorbed little. Humate had the highest maximum P sorption capacity (S(max)). Materials which had a low equilibrium P concentration (EPC(0)) and a high S(max) included aluminum and humate by-products. In a kinetic study, the Fe-DWTR, Ca-DWTR, aluminum, and magnesium by-product materials all removed P (to relatively low levels) from solution within 4 h. Phosphorus fractionation suggests that most materials contained little or no P that was readily available to water. Sand materials contained the greatest P fraction associated with fulvic and humic acids. In general, materials (not Ca-DWTR) and magnesium by-product were composed of sand-sized particles. There were no relationships between particle size distributions and P sorption in materials other than sands. The Ca- and Fe-DWTR, and magnesium by-product also contained plant nutrients and thus, may be desirable as soil amendments after being used to sorb P. Further, using Ca-DWTRs and Fe-DWTRs as soil amendments may also increase soil cation exchange and water holding capacity.

Hypercoagulation and thrombophilia in liver disease

A complex balance exists between endogenous procoagulants and the anticoagulant system in liver disease patients. Hypercoagulable events occur in cirrhosis patients despite the well-known bleeding diathesis of liver disease. These events may be clinically evident, such as in portal vein thrombosis or pulmonary embolism, but these conditions may also be a silent contributor to certain disease states, such as portopulmonary hypertension or parenchymal extinction with liver atrophy as well as thrombosis of extracorporeal circuits in dialysis or liver assist devices. Moreover, liver disease-related hypercoagulability may contribute to vascular disease in the increasingly common condition of non-alcoholic fatty liver disease. Despite the incidence of these problems, there are few widely accessible and practical laboratory tests to evaluate the risk of a hypercoagulable event in cirrhosis patients. Furthermore, there is little research on the use of commonly accepted anticoagulants in patients with liver disease. This article is a result of an international symposium on coagulation disorders in liver disease and addresses several areas of specific interest in hypercoagulation in liver disease. Critical areas lacking clinical information are highlighted and future areas of research interest are defined with an aim to foster clinical research in this field.