Supporting limb reconstruction patients: a fine-wire circular fixator support group

INTRODUCTION

External fixator frames are widely used in limb reconstruction surgery. They are used for relatively long periods and the multidimensional impact on patients is documented. We examined the role of a nurse-led specialist group when supporting patients both pre-operatively and postoperatively.

PATIENTS AND METHODS

All patients with external fixators were contacted via postal questionnaire. Questions asked covered regularity of attendance at the specialist group, information received and problems with the frames.

RESULTS

Thirty-seven patients replied. Twenty-one had attended the clinic and nearly all (32) had been offered the opportunity to attend. Most reported being well prepared for surgery and felt that the information given was satisfactory. Problems were generally addressed within the group and patients attended the group with frame-related problems before attending their general practitioner or the accident and emergency department. All patients found the group environment supportive.

CONCLUSIONS

We describe a unique patient support group. To our knowledge, it is the first in the country. It is a valuable resource in equipping patients prior to surgery as well as dealing with problems that arise with the frame in situ. We recommend it to other limb reconstruction units.

Computed tomography-guided radiofrequency ablation of osteoid osteomas

PURPOSE

To report on 14 patients with osteoid osteomas treated by computed tomography-guided radiofrequency ablation.

METHODS

Nine males and 5 females aged 13 to 45 (mean, 25) years with osteoid osteomas were included. The proximal tibia was the commonest site involved. A bipolar 18-gauge radiofrequency probe with a 9- mm active tip was used. A 4.5-mm hollow drill was introduced into the nidus. Energy application was started at 2 W and increased to a maximum of 5 W. Heat was applied for 4 to 6 minutes at 90 degrees Celsius.

RESULTS

12 (86%) of the 14 patients had prompt pain relief; the remaining 2 underwent a repeat ablation. After a mean follow-up period of 19 (range, 9-25) months, no patient had pain recurrence.

CONCLUSION

Radiofrequency ablation is a minimally invasive and cost-effective treatment for osteoid osteomas.

Pilimiction

Per urethral hair growth or passage of hair in the urine is a rare urological problem. It is pathognomonic sign of urinary bladder dermoid. Primary bladder dermoid is very rare problem. It could be managed endoscopically when it is limited to detrusor muscle. Secondary dermoid in the urinary bladder is not uncommon among the female specially during their reproductive life. It is mostly ovarian origin. Ovarian dermoid may grow and invade the urinary bladder wall to discharge its content in the urine. Cystoscopic evaluation followed by laparotomy and excision of ovarian dermoid along its extension to the urinary bladder is a rational approach. However if expertise is available it may be managed laparoscopically. Our patient has benign indolent coarse of pilimiction for last 9 years. Except US scans we did not do MRI or CT scan for financial constrain. Keeping an open mind we did cyst evaluation. Attempt of endoscopic resection seems that the dermoid has invaded bladder wall from out side. We did laparotomy in the same sitting. Lt. ovary was almost buried between the leaf of broad ligament and contain a dermoid cyst invading bladder wall to discharge its contents. So we confirm our diagnosis as secondary bladder dermoids as a cause of pilimiction & excise the whole specimen keeping its safety margin. Histopathologically it appears benign mature cystic teratoma.

Intranasal mucoadhesive buspirone formulation: in vitro characterization and nasal clearance studies

Oral administration is unsuitable for drugs prone to extensive first-pass metabolism, like buspirone. Thus, in the present study an attempt has been made to develop a mucoadhesive intranasal formulation improving permeation characteristics of buspirone HCl. Nasal formulations containing different concentrations of chitosan HCl and hydroxypropyl-beta-cyclodextrins (HP-beta-CD) were prepared and compared with control buspirone HCl solution regarding permeability, in vitro duration of mucoadhesion, in vivo nasal clearance in rats and in vitro cytotoxicity on cell culture. Nearly two fold increase in buspirone permeation was observed with 1% chitosan HCl and a 3.5 fold increase with 1% chitosan HCI and 5% HP-beta-CD. Nasal clearance studies showed retention of 50% radioactivity up to about 3.5 h for formulation F7 containing 1% chitosan HCI compared to 1.5 h for control buspirone solution (F1). Results conclusively demonstrated enhancement in permeation with no cytotoxicity. Thus formulations can be used to improve bioavailability of buspirone HCl.

Human papillomavirus type 16 reduces the expression of microRNA-218 in cervical carcinoma cells

Human papillomaviruses (HPVs) are involved in the pathogenesis of cancer of the cervix (CaCx). MicroRNA (miRNA) expression analysis using Ambion (Austin, TX, USA) arrays showed that three miRNAs were overexpressed and 24 underexpressed in cervical cell lines containing integrated HPV-16 DNA compared to the normal cervix. Furthermore, nine miRNAs were overexpressed and one underexpressed in integrated HPV-16 cell lines compared to the HPV-negative CaCx cell line C-33A. Based on microarray and/or quantitative real-time PCR and northern blot analyses, microRNA-218 (miR-218) was specifically underexpressed in HPV-positive cell lines, cervical lesions and cancer tissues containing HPV-16 DNA compared to both C-33A and the normal cervix. Expression of the E6 oncogene of high-risk HPV-16, but not that of low-risk HPV-6, reduced miR-218 expression, and conversely, RNA interference of E6/E7 oncogenes in an HPV-16-positive cell line increased miR-218 expression. We also demonstrate that the epithelial cell-specific marker LAMB3 is a target of miR-218. We also show that LAMB3 expression is increased in the presence of the HPV-16 E6 oncogene and this effect is mediated through miR-218. These findings may contribute to a better understanding of the molecular mechanisms involved in cervical carcinogenesis.

Dextrose prolotherapy for recalcitrant coccygodynia

PURPOSE

To present the results of dextrose prolotherapy undertaken for chronic non-responding coccygodynia in 37 patients.

METHODS

14 men and 23 women (mean age, 36 years) with chronic coccygodynia not responding to conservative treatment for more than 6 months were included. 27 of them had received local steroid injections. A visual analogue score (VAS) was recorded for all patients before and after injection of 8 ml of 25% dextrose and 2 ml of 2% lignocaine into the coccyx. In 8 patients with a VAS of more than 4 after the second injection, a third injection was given 4 weeks later.

RESULTS

The mean VAS before prolotherapy was 8.5. It was 3.4 after the first injection and 2.5 after the second injection. Minimal or no improvement was noted in 7 patients; the remaining 30 patients had good pain relief.

CONCLUSION

Dextrose prolotherapy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. Randomised studies are needed to compare prolotherapy with local steroid injections or coccygectomies.

Definite, probable or dubious: antioxidants trilogy in clinical dentistry

Recent years have shown the presence of free radicals in causation and progression of various dental diseases and antioxidant usage in dental therapeutics. Antioxidant micronutrients are important not only for limiting oxidative and tissue damage, but also in preventing increased cytokine production, which is a result of prolonged activation of the immune response. There has been a widespread availability and clinical claims on the safety and efficacy of antioxidants. However, lack of randomised controlled trials in dental research limits their usage. There is a substantial gap between these clinical claims and efficacy/safety of antioxidants in dental therapeutics which needs to be addressed. This article highlights the clinical significance of antioxidant therapy in dental practice and touches upon controversial areas and research lacunae. An evidence based approach for making recommendations about antioxidant usage and efficacy in routine dental practice seems to be the need of the hour.

The myth of nitrogen fertilization for soil carbon sequestration

Intensive use of N fertilizers in modern agriculture is motivated by the economic value of high grain yields and is generally perceived to sequester soil organic C by increasing the input of crop residues. This perception is at odds with a century of soil organic C data reported herein for the Morrow Plots, the world's oldest experimental site under continuous corn (Zea mays L.). After 40 to 50 yr of synthetic fertilization that exceeded grain N removal by 60 to 190%, a net decline occurred in soil C despite increasingly massive residue C incorporation, the decline being more extensive for a corn-soybean (Glycine max L. Merr.) or corn-oats (Avena sativa L.)-hay rotation than for continuous corn and of greater intensity for the profile (0-46 cm) than the surface soil. These findings implicate fertilizer N in promoting the decomposition of crop residues and soil organic matter and are consistent with data from numerous cropping experiments involving synthetic N fertilization in the USA Corn Belt and elsewhere, although not with the interpretation usually provided. There are important implications for soil C sequestration because the yield-based input of fertilizer N has commonly exceeded grain N removal for corn production on fertile soils since the 1960s. To mitigate the ongoing consequences of soil deterioration, atmospheric CO(2) enrichment, and NO(3)(-) pollution of ground and surface waters, N fertilization should be managed by site-specific assessment of soil N availability. Current fertilizer N management practices, if combined with corn stover removal for bioenergy production, exacerbate soil C loss.

Six cases of permanent alopecia after various conditioning regimens commonly used in hematopoietic stem cell transplantation

Alopecia, a side effect of chemotherapy, is usually temporary and reversible. Irreversible alopecia has been reported after high-dose chemotherapy (HDC) and hematopoietic stem cell transplantation (HSCT) especially related to BuCy containing conditioning regimens; however, the overall incidence is not known. We conducted a retrospective study to identify patients with chemotherapy-induced permanent alopecia after HSCT. We describe six such patients, two males and four females, among 760 patients transplanted between 1997 and 2004. Median age was 45 years (range, 37-65). There were three Caucasians and three African-Americans. Median follow-up was 30 months. Conditioning regimens included BuCy, Bu/Cy and etoposide (VP16) (one of these patients received second autograft after Cy and TBI) and CyVP16 and TBI. Our data show that permanent alopecia is a significant long-term side effect of HSCT and can be seen across the spectrum of diseases and transplant types and with non-busulfan containing regimens. We have observed that patients usually accept permanent alopecia as the price for the cure and therefore true incidence of permanent alopecia may be underestimated. Our findings may also have medico legal and psychosocial implications that need to be taken into consideration when consenting patients for HSCT.

External carotid ligation in extensive haemangioma of tongue & lip

Two patients were admitted in the surgical unit of Mymensingh Medical college Hospital on September 2005 & April 2006. The first case was a lady of 18 years presented with sudden huge enlargement of tongue & lower lip for 07 days resulting difficulty in deglutition & respiration. Since childhood she noticed multiple elevated bluish spots over the tongue, cheek & lips. The second case was a young man of 20 years presented with multiple diffuse swelling of lips, left side of face, cheek, lower eyelid since birth, which was gradually increasing in size. Colour Doppler evaluation of the lesions in both the cases revealed features suggestive of haemangioma. Bilateral external carotid artery ligation by skin crease incision at the level of upper border of thyroid cartilage was done in both the cases. In first case, tongue size reduced back to oral cavity in post operative period. After 04 weeks of operation tongue size became almost normal with only multiple bluish residual swelling. In second case, the swelling size gradually reduced in post operative period. Both the patients are under regular follow up.

Personal series with clinical review of fracture penis

Penile fracture is an uncommon Urological emergency. In flaccid state it allows significant degree of deformation without any injury to the vital structures but in erected state it is vulnerable to blunt injury. The tumescent corpora cavernosa may have got injured due to nonphysiological bending of penile shaft. The true incidence of penile fracture is not known even in western countries. It is either under reported or hidden for potential social embracement. We have reviewed all of our cases of penile fracture and has been conducted a retrospective study in the Department of Urology, Bangladesh Medical College, Dhaka. The study period was from October 2001 to January 2006. The sample size was 23. All patients have got classical history of penile fracture. The time between the onset of symptom and seeking of medical care ranges from 02 hours to 07 days. The diagnosis was made on the basis of history and clinical examination only. All the patients were underwent surgery. The potency was well preserved in all of our patients. The local tissue healing process is better among the patients, reported earlier. The overall result is excellent.

Tuberculosis of the sternum

A series of 14 patients suffering from tuberculosis of the sternum with a mean follow-up of 2.8 years (2 to 3.6) is presented. All were treated with antitubercular therapy: ten with primary therapy, two needed second-line therapy, and two required surgery (debridement). All showed complete healing and no evidence of recurrence at the last follow-up. MRI was useful in making the diagnosis at an early stage because atypical presentations resulting from HIV have become more common. Early adequate treatment with multidrug antitubercular therapy avoided the need for surgery in 12 of our 14 patients.

Association between glycaemic control and serum lipids profile in type 2 diabetic patients: HbA1c predicts dyslipidaemia

Impaired lipid metabolism resulting from uncontrolled hyperglycaemia has been implicated in cardiovascular complications in diabetes patients. The aim of this study was to examine the impact of glycaemic control on the lipid profile of diabetic patients. We also determined the ability of glycated haemoglobin (HbA(1c)) as an indirect marker of dyslipidaemia. A total of 1011 type 2 diabetic patients (males, 574; females, 437; mean age, 59.76 years) were included in this study. Venous blood samples were collected from all the subjects after at least 8 h fasting. The sera were analysed for HbA(1c), fasting blood glucose (FBG), total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL). The levels of HbA(1c), FBG and LDL did not differ significantly between males and females. Female patients showed significantly higher serum cholesterol and HDL but significantly lower TG levels as compared to males. There was a highly significant correlation between HbA(1c) and FBG. Both HbA(1c) and FBG exhibited direct correlations with cholesterol, TG and LDL and inverse correlation with HDL; the magnitude of significance for all these lipid parameters being greater with HbA(1c) than FBG. There was a linear relationship between HbA(1c) and dyslipidaemia. The levels of serum cholesterol and TG were significantly higher and of HDL significantly lower in patients with worse glycaemic control as compared to patients with good glycaemic control. The findings of this study clearly indicate that HbA(1c) is not only a useful biomarker of long-term glycaemic control but also a good predictor of lipid profile. Thus, monitoring of glycaemic control using HbA(1c) could have additional benefits of identifying diabetic patients who are at a greater risk of cardiovascular complications.

Intravesical migration of levonorgestrel-releasing intrauterine system (LNG-IUS) with calculus formation

The intrauterine contraceptive device (IUD) has been in use for many years as an effective means of birth control. Migration of the device from the uterus to the pelvic cavity is not uncommon and has been reported previously, however intravesical migration and secondary calculus formation is relatively rare. We report a 28-year-old woman in whom an intrauterine contraceptive device (LNG-IUS) migrated from the uterus to the bladder and resulted in stone formation. This case shows that the newer hormone releasing IUDs may also cause bladder perforation.

Utility of N terminal pro brain natriuretic peptide in elderly patients

OBJECTIVE

To evaluate the utility of N terminal pro brain natriuretic peptide (NT-proBNP) as a diagnostic marker for diastolic dysfunction or failure, systolic dysfunction, and significant valve disorders in patients over 75 years.

DESIGN

Cohort study.

SETTING

Outpatient echocardiography service in a district general hospital.

PARTICIPANTS

100 consecutive patients.

MAIN OUTCOME MEASURES

Sensitivity, specificity, positive predictive values, negative predictive values, and area under receiver operating characteristic curve for NT-proBNP assay in the diagnosis of left ventricular diastolic dysfunction or failure, systolic dysfunction, and significant valve disorders.

RESULTS

For diagnosis of systolic dysfunction NT-proBNP level of 424 pg/ml had a sensitivity of 96%, specificity of 45%, positive predictive value of 36%, and negative predictive value of 96%. The area under the curve was 0.71 (95% confidence intervals: 0.69 to 0.89). In valve heart disease, level of 227 pg/ml had sensitivity of 91%, specificity of 43%, positive predictive value of 40%, and negative predictive value of 92%. Patients with diastolic dysfunction/failure had lower plasma concentrations.

CONCLUSIONS

This study showed that NT-proBNP had excellent negative predictive value for systolic dysfunction and significant valve disorders in very elderly patients. It increased significantly in systolic dysfunction, valve heart disease, and atrial fibrillation. NT-proBNP is not useful in the diagnosis of diastolic dysfunction or diastolic heart failure using standard echocardiography criteria.

Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. A review of 72 cases with long-term follow-up

Aneurysmal bone cyst is a rare tumour-like lesion which develops during growth. Our aim was to determine the efficacy of the administration of percutaneous intralesional 3% polidocanol (hydroxypolyaethoxydodecan) as sclerotherapy. Between July 1997 and December 2004 we treated 72 patients (46 males, 26 females) with a histologically-proven diagnosis of aneurysmal bone cyst, at various skeletal sites using this method. The sclerotherapy was performed under fluoroscopic guidance and general anaesthesia or sedation and local anaesthesia. The mean follow-up period was 34 months (26.5 to 80). The patients were evaluated using the Enneking system for functional assessment and all the lesions were radiologically quantified into four grades. The mean age of patients was 15.6 years (3 to 38) and the mean number of injections was three (1 to 5). Ten patients were cured by a single injection. The mean reduction in size of the lesion (radiological healing) was found to be 76.6% (61.9% to 93.2%) with a mean clinical response of 84.5% (73.4% to 100%). Recurrence was seen in two patients (2.8%) within two years of treatment and both were treated successfully by further sclerotherapy. Percutaneous sclerotherapy with polidocanol is a safe alternative to conventional surgery for the treatment of an aneurysmal bone cyst. It can be used at surgically-inaccessible sites and treatment can be performed on an out-patient basis.

Isolated tuberculosis of the coccyx

Vertebral disease constitutes approximately 50% of all skeletal tuberculosis. We describe a patient who developed a discharging sinus at the tip of the coccyx. Extensive examination revealed isolated tuberculosis of the coccyx. Although rare, the condition should be suspected in patients presenting with a chronic sinus in the sacrococcygeal area and a lytic lesion in the coccyx on CT or MRI, particularly in the developing world.

Genetic and biochemical characterization of the Streptococcus pneumoniae PcrA helicase and its role in plasmid rolling circle replication

PcrA is a chromosomally encoded DNA helicase of gram-positive bacteria involved in replication of rolling circle replicating plasmids. Efficient interaction between PcrA and the plasmid-encoded replication initiator (Rep) protein is considered a requirement for the plasmid to replicate in a given host, and thus, the ability of a Rep protein to interact with heterologous PcrA helicases has been invoked as a determinant of plasmid promiscuity. We characterized transcription of the Streptococcus pneumoniae pcrA gene in its genetic context and studied the biochemical properties of its product, the PcrA(Spn) helicase. Transcription of the pneumococcal pcrA gene was directed by promoter Pa, consisting of an extended -10 box. Promoter Pa also accounted for expression of a second essential gene, radC, which was transcribed with much lower efficiency than pcrA, probably due to the presence of a terminator/attenuator sequence located between the two genes. PcrA(Spn) displayed single-stranded DNA-dependent ATPase activity. PcrA(Spn) showed 5'-->3' and 3'-->5' helicase activities and bound efficiently to partially duplex DNA containing a hairpin structure adjacent to a 6-nucleotide 5' or 3' single-stranded tail and one unpaired (flap) nucleotide in the complementary strand. PcrA(Spn) interacted specifically with RepC, the initiator of staphylococcal plasmid pT181. Although the pneumococcal helicase was able to initiate unwinding of the RepC-nicked pT181 DNA, it was much less processive in this activity than the cognate staphylococcal PcrA protein. Accordingly, PcrA(Spn) was inefficient in in vitro replication of pT181, and perhaps as a consequence, this plasmid could not be established in S. pneumoniae.

An Unusual Case Of Talonavicular Dislocation With Associated Ipsilateral Foot Fractures

We describe a previously unreported form of a talonavicular dislocation complicated by navicular, talar neck and open calcaneal fractures. Prompt recognition and rapid reduction of fractures and dislocations gives the best possible outcome. The presence of serious distracting injuries can alter priorities, however the "lesser" injuries often lead to long term morbidity after recovery from the life-threatening injuries.

Microcystin-LR and kinetics of cytoskeletal reorganization in hepatocytes, kidney cells, and fibroblasts

Microcystin-LR (MCLR) is a cyanobacterial hepatotoxin that inhibits protein phosphatases 1 and 2A. To characterize cytoskeletal changes over time, hepatocytes were incubated with the toxin at 13.3 microM for 0, 2, 4, 6, 8, 16, 32, or 64 minutes. Changes in the hepatocytes were compared to those in cultured kidney cells and skin fibroblasts incubated with the toxin at 133 microM for 0, 2, 4, 8, 12, 16, or 24 hours. Cells were fixed and incubated with rhodamine-conjugated phalloidin, or primary antibodies against beta-tubulin and either vimentin or cytokeratin intermediate filaments (IFs), followed by fluorescein-conjugated secondary antibodies. The number of affected cells per 400 counted (NAC) with alterations in a specific cytoskeletal element were determined at each time point. In fibroblasts as well as kidney cells, changes occurred first in IFs, followed by microtubules (MTs), and later microfilaments (MFs). In some hepatocytes, IFs were affected first, but after 16 minutes, the NAC with altered MTs exceeded the NAC with alterations in other cytoskeletal elements. In both hepatocytes and non-hepatocytes, IFs and MTs condensed and collapsed around the nucleus. MFs similarly collapsed, but some of the actin radiated outward, producing a star-like appearance. The similarity of the cytoskeletal changes induced by MCLR in hepatocytes and non-hepatocytes suggests a common mechanism of action. Differences among cell types in sequential cytoskeletal alterations may be due to differences in phosphorylation of intracellular proteins.

Raman and AFM studies of swift heavy ion irradiated InGaAs/GaAs heterostructures

The effect of swift heavy ion (SHI) irradiation on InGaAs/GaAs heterostructures is studied using Raman spectroscopy and atomic force microscopy (AFM). The structures consist of molecular beam epitaxy (MBE) grown InGaAs layers on GaAs(001), having layer thicknesses of 12, 36, 60 and 96 nm. After irradiation, the GaAs type longitudinal optical (LO) mode blue shifted to higher frequency in thin samples and red shifted towards lower frequency in thick samples. These results are discussed invoking the penetration depth of the probe radiation (λ = 514.5 nm) in InGaAs. Deconvoluting the Raman spectra of thin samples indicates a compressive strain developed in the substrate, close to the interface upon irradiation. This modification and diffusion of indium across the interface results in an increase of strain and reduction of the defect densities in the InGaAs layer. The variations in FWHM of the Raman modes are discussed in detail. The surface morphology of these heterostructures has been studied by AFM before and after SHI irradiation. These studies, combined with Raman results, help to identify different relaxation regimes.

Effect of nanoparticle nature on hydrogen concentration profiles and improved switching characteristics in Gd switchable mirrors

A detailed elastic recoil detection analysis using 40 MeV 28Si5+ ions has been carried out to study the changes in the H concentration and concentration profiles during the hydrogenation/dehydrogenation process in polycrystalline and nanoparticle Gd layers formed using vacuum evaporation and inert gas evaporation techniques, respectively. Nanoparticle sample exhibits a larger difference in the [H]/[Gd] values (2.9 and 1.7) in comparison to polycrystalline sample (2.4 and 2.0) in the loaded and deloaded states. Hydrogenation/dehydrogenation activity is restricted to the top portion in case of polycrystalline sample. In contrast to this, size induced structural transformation; enhanced surface area and the presence of large number of inter particle boundaries due to nanoparticle character result in the complete Gd layer becoming active during switching.

The local hormonal environment and related biomarkers in the normal breast

Recent developments in breast epithelial sampling techniques (nipple fluid aspiration, ductal lavage, and random fine needle aspiration) provide new opportunities for the acquisition of hormonal and cellular biomarker data in asymptomatic women, and thereby the possibility of developing a unified vision of how the hormonal environment of the breast may interact with the cellular expression of proteins, and with other evolving candidate markers of breast cancer risk. The purpose of this review is to integrate available information regarding cellular and breast fluid biomarkers of hormone action on the breast, to identify candidate biomarkers for studies of breast cancer risk and prevention. These include the estrogen receptors alpha and beta, markers of proliferative and apoptotic response, and protein markers of estrogen action in breast cells and nipple fluid. Studies of breast hormone levels in nipple aspiration fluid (NAF) show that estrone sulphate is present in large quantities in the normal breast, while the differences in serum ovarian steroids that are seen in pre- and postmenopausal women are blunted in NAF. The variability of several estradiol precursors in NAF over time is relatively small, a useful attribute of potential biomarkers of breast cancer risk, particularly if they are reversible with intervention in Phase 2 prevention trials. These studies are already providing new insights into the hormonal etiology of breast cancer, and should lead to the identification of robust, reversible biomarkers for use in breast cancer prevention studies.

Biodiversity of mosquitoes in Manipur State and their medical significance

Entomological studies conducted during monsoon and post-monsoon season in Manipur State revealed the presence of fifty-five species of mosquitoes under ten genera. Out of the seventeen Anopheles species recorded, Anopheles aconitus, An. dirus and An. nivipes were recorded for the first time from the state. The present study has confirmed the existence of An. dirus, the major malaria vector in the Northeast from a selected area of the state. Among Culicines, four species viz., Aedes nigrostriatus, Malaya genurostris, Aediomyia catasticta and Toxorhynchites splendens which were not reported earlier from this state have been recorded in the present study. With the addition of these seven species of mosquitoes to the earlier record of mosquitoes so far reported from Manipur, the mosquito fauna swells up to one hundred and eleven including the major vectors of malaria of the Northeast and the potential vectors of Japanese encephalitis and dengue virus transmission in India.

Breast-tissue sampling for risk assessment and prevention

Breast tissue and duct fluid provide a rich source of biomarkers to both aid in the assessment of short-term risk of developing breast cancer and predict and assess responses to prevention interventions. There are three methods currently being utilized to sample breast tissue in asymptomatic women for risk assessment: nipple-aspirate fluid (NAF), random periareolar fine-needle aspiration (RPFNA) and ductal lavage. Prospective single-institution trials have shown that the presence of atypical cells in NAF fluid or RPFNA specimens is associated with an increased risk of breast cancer. Furthermore, RPFNA-detected atypia has been observed to further stratify risk based on the commonly used Gail risk-assessment model. A prospective trial evaluating risk prediction on the basis of atypical cells in ductal-lavage fluid is ongoing. The ability of other established non-genetic biomarkers (mammographic breast density; serum levels of bioavailable estradiol, testosterone, insulin-like growth factor-1 and its insulin like growth factor binding protein-3) to stratify risk based on the Gail model is as yet incompletely defined. Modulation of breast intra-epithelial neoplasia (i.e. hyperplasia with or without atypia) with or without associated breast-tissue molecular markers, such as proliferation, is currently being used to evaluate response in Phase II chemoprevention trials. RPFNA has been the method most frequently used for Phase II studies of 6-12 months duration. However, ductal lavage, RPFNA and random and directed core needle biopsies are all being utilized in ongoing multi-institutional Phase II studies. The strengths and weaknesses of each method are reviewed.

A DNA recombination-based approach to eliminate papillomavirus infection

At present, no treatments exist that effectively target and eliminate papillomaviruses (PVs) from infected cells or prevent its replication. We are employing a strategy to prevent virus replication in PV-infected cells through the conditional expression of the herpes simplex virus type 1 thymidine kinase (TK) gene. Expression of TK in this system is expected to be triggered by a homologous recombination event between the endogenous PV genome and a nonexpressing TK gene cassette. Recombination between these two DNAs is expected to change the nonexpressing cassette into a form that expresses TK. Various constructs were generated to express the TK in the above manner. Transfection of cell lines with a TK nonexpressing plasmid did not result in TK production due to alternative splicing and polyadenylation site selection. However, cotransfection of cell lines with PV plasmids along with the above TK construct containing short segments of PV sequences resulted in a recombination event that led to TK expression as shown by Northern and Western blot analyses. We also developed a TK expression cassette utilizing an adeno-associated virus (AAV) vector. Delivery of the cassette by AAV to PV-infected cells resulted in TK expression, and ganciclovir treatment resulted in efficient killing of these cells.

Isolation and molecular characterization of fluoroquinolone-resistant Escherichia coli from poultry litter

Nineteen fluoroquinolone-resistant Escherichia coli strains were isolated from poultry litter. Sixteen of the 19 strains were serotyped to groups 6, 8, 53, 56, 153, and 174. Three strains were not serotyped to any known group. All isolates were resistant to multiple antibiotics. Most strains were resistant to gentamicin, kanamycin, chloramphenicol, and streptomycin. Ribotyping of the multidrug-resistant isolates with restriction enzyme PvuII showed 5 different ribogroups, suggesting independent development of resistance instead of clonal spread. Quinolone resistance was associated with mutations of the quinolone resistance-determining region (QRDR) of the gyr A gene in all cases. To determine the incidence of gyr A mutations in fluoroquinolone-resistant E. coli isolates, a rapid PCR-based assay was used by amplifying a 164-bp region of the gyr A gene containing the mutation sites followed by digestion of the PCR product with restriction enzyme HinfI. A higher level of resistance to ciprofloxacin [minimum inhibitory concentration (MIC) >4 microg] was associated with double mutations, but the mutants with a low level of resistance (MIC <2 microg) had only a single mutation. Those strains that were ciprofloxacin-resistant (MIC <2 microg) had a single mutation of a C-to-T transition at position 248 (Ser 83-->Leu) or a G-to-A transition at position 259 (Asp 87-->Asn). The ciprofloxacin-resistant (MIC >4 microg) isolates had mutations at both positions. Fluoroquinolone resistance was present among different serotypes and ribotypes, and drug resistance profiles suggest that the incidence of resistance does not indicate a clonal population in avian E. coli.

Holmium YAG laser treatment of superficial bladder carcinoma

Holmium YAG laser is one of the new modalities of treatment of urinary bladder tumor. Thirty patients of superficial bladder carcinoma were selected from the Urology out patient department of Dhaka Medical College Hospital from January 2004 to July 2004. Among thirty cases, 18 were recurrent and 12 were primary superficial bladder carcinoma. Out of thirty patients, 24 were male and six were female. Patients were treated with Holmium YAG laser under spinal anesthesia. Before resection, cold cup biopsy were taken from the apex and after resection of the tumor, another cold cup biopsy were taken from the base of the tumor. Holmium YAG laser therapy was given with a 550 micron end firing quartz laser fiber through the working element of resectoscope. Small tumors (< 1 cm) were ablated and large tumors (1-4 cm) were resected. The initial laser setting was 0.5 to 0.8 J and 10 Hz. For resection of the tumor, a slightly higher energy of 1 to 1.2 J was used at 10 to 12 Hz. After resection, bleeding vessels were coagulated. The resected tumor was evacuated by Elik's evacuator. All cases were followed for 6 to 12 months by history, physical examination, urine analysis, sonogram and cystoscopy three monthly. Bleeding was minimum during the procedure and no transfusion was required. Complications like obturator jerk, clot retention or perforation were not developed. No recurrence was found during the 6 to 12 months follow up period. The procedure was found safe, effective, and acceptable. The study was conducted to evaluate the initial result of Holmium YAG laser for the treatment of superficial bladder carcinoma. We warrants further studies in this regard.

A focus of lymphatic filariasis in a tea garden worker community of central Assam

A survey for lymphatic filariasis was conducted among tea garden workers of central Assam. Of the 656 night blood samples examined, 31 were found positive for Wuchereria bancrofti parasite (microfilaria rate 4.7%). Microfilaria rate was higher in male (7.3%) than females (2.1%). Culex quinquefasciatus was incriminated as vector mosquito.

Holmium laser urethrotomy for urethral stricture

A prospective cross-sectional study was carried-out in the department of urology, Dhaka Medical College Hospital (DMCH) to evaluate the outcome of Laser urethrotomy for the treatment of urethral stricture. For this purpose, 30 male patients aged 15 to 60 years with short segment anterior urethral stricture (>2cm) were treated by HO:YAG Laser. The energy used for this purpose was 0.8 to 1.5 joules by LISA 80 Watt Holmium Laser machine. All patients were catheterized for less than 24 hours and were followed up for 6 to 12 months postoperatively by uroflowmetry and by retrograde with voiding cystourethrogram 3 monthly. The study revealed that out of 30 patients, 27(90%) showed good flow of urine (Qave>16.0 ml/sec) and adequate caliber urethra in retrograde urethrogram (RGU). Only 3(10%) patients showed narrow stream of urine (Qave<8.0 ml/sec) and recurrent stricture in RGU which were managed by optical internal urethrotomy (OIU) and clean intermittent self catheterization (CISC). The study showed satisfactory results in 90% cases with short term follow up. The study concludes that HO:YAG Laser urethrotomy for the treatment of short segment urethral stricture is highly effective. The study further reveals that the method is simple, safe and thus, it can be considered favorably as a new therapeutic option for the treatment of urethral stricture. However, long term follow up is necessary for making a final comment on this issue.

Risk factors for clinical infection in patients colonized with methicillin resistant Staphylococcus aureus (MRSA)

OBJECTIVE

To identify the risk factors involved in development of infection in individuals colonized with Methicillin-resistant Staphylococcus aureus (MRSA) among intensive care unit (ICU) patients.

METHODS

A total of 1431 patients were admitted in ICU of which 63 grew MRSA during January 1998 to December 1999. Patients who developed infection with MRSA in less than 48 hours of their admission to ICU were excluded. Medical records of all patients who grew MRSA were reviewed and 57 patients were identified for inclusion in the study. Thirty-seven of these had features of infection with MRSA and were selected as cases and 20 were identified as asymptomatic colonizers and labeled as controls. Risk factors like age of the patient, duration of ICU stay, gender, co-morbidity, presence and duration of central lines, number of arterial-punctures and number and duration of intubations were compared between cases and controls.

RESULTS

Cases were found to be significantly older (52.8 +/- 15.1) than controls (34.9 +/- 21.2). Other identified risk factors were diabetes mellitus (p = 0.001) and the first 15 days of central line placement (p = 0.025). Although chronic liver disease and hypertension could not be identified as significant risk factors, they clearly showed association. Other risk factors were not significantly different from controls.

CONCLUSION

It is suggested that greater care is required for the elderly, diabetic patients with a central venous line in place especially during the first fifteen days of its introduction.

Morphological study of liver biopsy in Thalassaemia major

OBJECTIVE

To see the morphological changes in liver in transfusion dependent Thalassaemia major children undergoing bone marrow transplantation.

METHODS

This retrospective cross-sectional survey was conducted at Pathology department of Army Medical College and Paediatric department of Military Hospital, Rawalpindi from Jul 2000 to Aug 2003. Liver biopsies were done in 40 thalassaemic major children and histological changes including Knodell Histological activity index (HAI); grade, stage and score along with degree of haemosiderosis were noted. Serum ALT levels, ferritin assays and screening for HBsAg and Anti- HCV antibody were also carried out in these cases.

RESULTS

Forty children 1.5-10.5 years of age (mean 6.1 years) with a male to female ratio of 1.2:1 were included in the study. According to Knodell HAI scoring, 24 (60%) cases had Knodell HAI score between 13/22 to 18/22 and 18 patients (45%) in grade 9-12/18. Six children had fully developed cirrhotic changes whereas 22 and 12 patients showed stage 3 and 1 respectively. Twenty eight (70%) patients had grade 3-4 haemosiderosis. HBsAg was positive in 6 and anti- HCV antibody in 14 patients. Serum ferritin and ALT levels were markedly raised in most of the patients.

CONCLUSION

Seventy percent patients had moderate to severe haemosiderosis and high Knodell HAI score was found in children with severe haemosiderosis, raised ALT and Ferritin levels and with positive serology for HBsAg and anti- HCV antibody. Liver biopsy is useful in thalassaemic children to assess the stage of liver disease and selection of suitable cases for bone marrow transplantation (BMT).

Comparison of optimal malarial test with light microscopy for the diagnosis of malaria

OBJECTIVE

To evaluate the efficacy of a parasite lactate dehydrogenase-based immunochromatographic antigen detection assay (optimal) against conventional light microscopy in the diagnosis of malaria at Military Hospital, Rawalpindi and Department of Pathology Army Medical College Rawalpindi from August to October 2002 in patients reporting sick with history suggestive of malaria.

METHODS

The blood samples were collected from 215 patients reporting with symptoms suggestive of malaria. Thick and thin blood films were prepared, stained with Leishman's stain and examined by light microscopy for the presence of malarial parasites. Parasitaemia was estimated on all positive slides. All samples were tested for presence of malarial parasite by optimal dipstick method according to the manufacturer's instructions.

RESULTS

A total of 215 cases were studied. Malarial parasites were visualized in 98 (45.5%) cases with light microscopy. Optimal test revealed 93 (43.2%) of these samples as positive. Microscopy showed 61 out of 98 positive cases to be P. vivax and 37 P. falciparum. The Optimal dipstick method revealed that 58 out of 93 were positive for P. vivax and 35 positive for P. falciparum. These results demonstrated that Optimal had sensitivities of 95% and 94.5% for P. vivax and P. falciparum respectively. It has 100% specificity for both malarial species, when compared to conventional microscopy.

CONCLUSION

Optimal test showed excellent correlation with microscopy in the diagnosis of P. vivax and P. falciparum. It is expensive but it has an advantage of being simple, rapid and effective test in the diagnosis of malaria especially where well trained microscopists are not available or work load is too high.

Dehydroepiandrosterone sulfate increases hepatic ubiquinone-9 in male F-344 rats

Administration of dehydroepiandrosterone sulfate (DHEAS) for 14 days caused a significant increase in the total ubiquinone-9 level in the hepatic tissue of male F-344 rats (p < 0.05). Hepatic ubiquinone-10 level of DHEAS-treated rats however, was found not to be statistically different from control animals. These findings suggest that peroxisome proliferator DHEAS displays typical hepatic response in increasing ubiquinone concentration in the rat.

Factors affecting rates of infection and nonunion in intramedullary nailing

We report a retrospective study over five years to determine the incidence of infection and nonunion after intramedullary nailing in fractures of 214 long bones; 122 femoral, 75 tibial and 17 humeral. The indications for nailing were trauma (n = 161), pathological fracture (n = 30) and nonunion (n = 23). There were 30 open fractures. The overall rates of deep infection and nonunion were 3.8% and 14.2%, respectively. Using multiple logistic regression analysis, we determined the relationships between deep infection and nonunion and the pre- and peri-operative factors of age, ASA score, indication for nailing, the use of reaming, the use of antibiotics, whether the fracture was open and the operating time. Open fractures were found to be significantly associated with deep infection. The length of the operation may also affect the outcome. Opening of the fracture at the time of surgery and the ASA score were found to be significantly associated with the development of nonunion after intramedullary nailing. We have compared our findings with previously published data from large teaching hospital units.

Entomological observations on dengue vector mosquitoes following a suspected outbreak of dengue in certain parts of Nagaland with a note on their susceptibility to insecticides

Three species of Aedes viz., Aedes albopictus, Aedes aegypti and Aedes annandalei were detected from different breeding sources in and around human habitats during entomological study conducted following an outbreak suspected to be of dengue (which occurred during, 1994) in parts of Medziphema PHC area of Nagaland in two different points of time ie., in the year, 1994 and, 2000. The potential dengue vector, Aedes albopictus showed high preponderance by breeding in all types of containers searched with high Breteau Index (BI) value of 85.0 and 72.72 recorded in, 1994 and, 2000 respectively whereas the BI value for other potential vector, Aedes aegypti was recorded low (4.9) in the year, 1994 with a substantial increase (31.81) in, 2000. The change in ecosystem along with the process of urbanization has facilitated the growth of these dengue vector mosquitoes in the area of investigation. Adults of both Aedes aegypti and Aedes albopictus were found to be susceptible to DDT, dieldrin and malathion in insecticide bioassay carried out using WHO test kit.