A boy with acute urinary retention: a Mullerian duct remnant (2006: 3b)

Vestiges of the Mullerian duct systems are found in the male and these may occasionally give rise to symptoms. We report a case of acute urinary retention in a male child secondary to a Mullerian duct remnant. Subsequent MRI was done to reach the final diagnosis.

Bacterially expressed and refolded envelope protein (domain III) of dengue virus type-4 binds heparan sulfate

An arboviral infection like dengue fever/dengue hemorrhagic fever (DHF) with high morbidity and mortality rate are extensively prevalent in several parts of the world. Global efforts have been directed towards development of vaccine for prevention of dengue. However, lack of thorough understanding about biology and pathogenesis of dengue virus restricts us from development of an effective vaccine. Here we report molecular interaction of domain III of envelope protein of dengue virus type-4 with heparan sulfate. A codon optimized synthetic gene encoding domain III of dengue virus type-4 envelope protein was expressed in Escherichia coli and purified under denaturing conditions, refolded and purified to homogeneity. Refolded Den4-DIII was characterized using biochemical and biophysical methods and shown to be pure and homogeneous. The purified protein was recognized in Western analyses by monoclonal antibody specific for the 6x His tag as well as the H241 monoclonal antibody. The in vitro refolded recombinant protein preparation was biologically functional and found to bind cell free heparan sulfate. This is the first report providing molecular evidence on binding of dengue-4 envelope protein to heparan sulfate. We developed a homology model of dengue-4 envelope protein (domain III) and mapped the possible amino acid residues critical for binding to heparan sulfate. Domain III envelope protein of dengue virus is a lead vaccine candidate. Our findings further the understanding on biology of dengue virus and will help in development of bioassay for the proposed vaccine candidate.

Efficacy and safety of kanamycin, ethionamide, PAS and cycloserine in multidrug-resistant pulmonary tuberculosis patients

BACKGROUND

We carried out this study to determine the efficacy and safety of a regimen containing kanamycin, ethionamide, isoniazid, para-aminosalicylic acid (PAS) and cycloserine in the treatment of multidrug-resistant tuberculosis (MDR-TB).

METHODS

A prospective, uncontrolled study of 39 pulmonary tuberculosis patients, who had received adequate first-line antituberculosis treatment including supervised category II retreatment regimen, and were still sputum smear positive for acid-fast bacilli (AFB) in whom sputum culture revealed isolates of M. tuberculosis resistant to rifampicin and isoniazid with and without resistance to other antituberculosis drugs. They received kanamycin (initial 4-6 months), ethionamide, isoniazid, PAS and cycloserine for a minimum period of two years.

RESULTS

Out of 39 patients, 29 (74.3%) achieved sputum conversion within six months and remained so at the end of two years. Two (5.1%) patients died, six (20.6%) patients were lost to follow up, and two (5.1%) patients remained sputum smear-positive for AFB through out the period of study. Twenty-nine patients, declared cured, were followed for an average period of 16 months (3-48 months), during which two (6.9%) patients relapsed, four (13.8%) patients were lost to follow-up and remaining 23 remained sputum smear-negative. Eight (21.1%) patients developed major side effects which required stoppage/change of drugs.

CONCLUSION

In MDR-TB patients, regimen consisting of ethionamide, isoniazid, PAS and cycloserine and kanamycin appears to be effective and safe.

Prediction model for peak expiratory flow in North Indian population

OBJECTIVE

To establish a model for predicting peak expiratory flow rate (PEFR) in North Indian healthy population. Study subjects. Eight hundred and ninety-seven healthy, non-smoker individuals (681 males and 216 females) in the age group of 10-60 years.

METHODS

The study was carried out at a health exhibition organised by the Government of Uttar Pradesh, at King George's Medical University, Lucknow. Only healthy, non-smoker individuals were enrolled for the study. Age was noted in completed years and weight in kg and height in cm were taken without shoes. PEFR was measured by Mini Wrights peak flow meter in standing position after prior instructions and demonstration of technique to each individual. The test was performed three times on each subject and best of the three attempts was selected for data computation. The statistical solftware SPSS was used to fit the model and perform residual analysis.

RESULTS

The highest reading for males was recorded in the age group of 20 to 24 years and for females in the age group of 25 to 29 years. Using age, height and weight, we established a regression model for predicting PEFR values for males and females separately in the age group 19-60 years. In the age group 10-18 years, the model for predicting PEFR was same for both the sexes. PEFR values were found to be more in males as compared to females. The predictive power of the model as described by explained variation was found to be 80 and 82 percent for males and females, respectively.

CONCLUSIONS

Prediction model for north Indian subjects was drafted for age range 10-60 years. While separate models were required for males and females because of sex related differences in the age group 19-60 years, a common model sufficed for age group 10-18 years.

Evaluation of self-care manual in bronchial asthma

BACKGROUND

Asthma continues to be a substantial cause of morbidity. Various educational programmes have shown an increase in knowledge and self-management skills of asthmatic patients and also revealed a reduction of severe attacks, hospitalisations and days lost from work.

METHODS

A self-care manual on bronchial asthma was prepared. A total of 523 bronchial asthma patients were enrolled in the study. Out of these, 260 patients were included in the study group to whom self-care manual was provided and 263 were included in the control group to whom no specific instructions were given. After the initial interview (0 week), follow up of all the patients was carried out at two weeks, six months and at one year.

RESULTS

Out of the enrolled patients, 240 (92.31%) and 240 (91.25%), 212 (81.54%) and 210 (79.85%), and 204 (78.46%) and 194 (73.76%) patients completed the follow up at two weeks, six months and one year in the two groups, respectively. Various parameters analysed were knowledge of the patients, their symptomatology, various triggering factors which were inducing and/or precipitating symptoms, the self-care measures they adopted at the time of acute attacks and the indices of asthma morbidity during the last one year. The knowledge scores were significantly higher at all the three follow up visits (F = 633. 98, p < 0.001) as compared to the baseline in the study group patients. In both the groups, the symptom scores decreased at all the follow up visits (F = 71.78, p < 0.001 in the study group and F = 24.19, p < 0.001 in the control group). Multiple logistic regression analysis showed a significant improvement in knowledge and symptoms in the study group as compared to controls after adjusting for various confounding variables (p < 0.001). The number of patients whose symptoms were induced and/or precipitated by exposure to various triggering factors was significantly reduced in study group for all the triggers. There was a statistically significant decrease in the number of severe attacks, number of emergency visits and need of injections during last one year in both the groups, though the differences were more marked in the study group. However, there was a significant decrease in hospital admissions and absence from school/or job in the study group at one year as compared to the control group.

CONCLUSION

The self-care manual was effective in self-management of bronchial asthma.

A girl with abnormal head and eye movements: Joubert syndrome (2005:3b)

We describe a mentally retarded patient with developmental delay, abnormal head and eye movements with suspected blindness and episodes of abnormal breathing. Subsequent CT and MRI were performed to reach to the final diagnosis. The clinical history and the imaging findings were classical for Joubert syndrome.

Search for new prototypes for the chemotherapy of filariasis: a chemotherapeutic and biochemical approach

The antifilarial activity of two coumarin derivatives (A, B) and three glycosyl amine derivatives (D, E, F) was evaluated against a subperiodic strain of human lymphatic filarial parasite Brugia malayi by the intraperitoneal route at 50 mg/kg for 5 consecutive days. Of these, the two sugar derivatives (D and E) were selected for evaluation by the oral route based on their microfilaricidal (mild), macrofilaricidal and female worm sterilization efficacy using the i.p. route of administration. Compound E was finally selected for combination therapy on the basis of its microfilaricidal and embryostatic action by the oral route and its spectrum of activity against micro- and macrofilariae including embryostatic activity by the i.p. route. In addition, E also significantly inhibited the parasite DNA topoisomerase II. Compound A, in contrast, led to an enhanced adult worm burden. Compound B was toxic by the i.p. route, killing all of the treated animals before completion of the experiment. Some of these compounds demonstrated significant antifilarial efficacy of varying degree when tested in vitro Compounds B, D and F also killed adult B. malayi in vitro at 100 muM while 50 muM resulted in very slow motility of worms. Compound E in combination with a promising macrofilaricidal benzopyran derivative reported by us recently (compound C) did not show any synergistic or additive effect. These two compounds (C and E) individually on oral administration with either DEC or ivermectin significantly improved microfilaricidal efficacy in terms of intensity and duration of suppressed microfilaraemia. The combination of DEC with compound E demonstrated marginal enhancement in adulticidal efficacy, however, the embryostatic effect of the duo was significantly higher than that exerted by the individual agents. It may thus be inferred that in the absence of an adulticidal antifilarial drug, the use of potential antifilarials in combination with the standard filaricides may yield better results.

Accidental ligature strangulation deaths in East Delhi (India)

Ligature strangulations are usually homicidal. Accidental cases are quite uncommon, especially among adults. A retrospective ten-year study conducted in East Delhi revealed that in a total of 98 cases of death due to strangulation, five cases (approximately 5%) among all medico-legal deaths were of fatal ligature strangulation, involving adults who were neither intoxicated nor indulging in paraphiliac activity. The causative agent in three cases was a cycle rickshaw, in one case it was a rotatory part of a machine, and the fifth case occurred due to entanglement while tying up a cow. The cases and their autopsy findings have been described in this paper, together with the review and preventive aspects of such cases.

Effect of garlic (Allium sativum) oil on exercise tolerance in patients with coronary artery disease

The effect of six weeks garlic oil administration was observed on cardiac performance and exercise tolerance in 30 patients of coronary artery disease. After initial treadmill stress test, they were administered garlic oil in the dose of four capsules twice a day for 6 weeks and treadmill stress test was repeated. Garlic significantly (P<0.01) reduced heart rate at peak exercise and also significantly reduced the work load upon the heart resulting in better exercise tolerance (P<0.05) as compared to the initial test. It appears to be a good adaptogen to be utilized in patients with coronary artery disease.

Protective effect of ginger, Zingiber officinale Rosc on experimental atherosclerosis in rabbits

The effects of air dried ginger powder (0.1g/kg body weight, po, for 75 days) were studied on experimentally induced atherosclerosis in rabbits by cholesterol feeding (0.3g/kg body weight, po). Cholesterol feeding for 75 days lead to distinct development of atheroma in the aorta and coronary arteriesof the rabbits and this was significantly inhibited by about 50% following ginger administration. There was distinct decrease in lipid peroxidation and enhancement of fibrinolytic activity in ginger treated animals. However, ginger did not lower blood lipidsto any significant extent. This distinct protection from the development of atherosclerosis by ginger is probably because of its free radical scavanging, prostaglandin inhibitory and fibri properties.

Surgeons-Take care of pre and par-Surgical rituals

Surgeons must become convinced regarding the strict adherence to a meticulous operating room ritual and an equally careful aseptic technique for the pre and post opcrative care Surgeons have lived with the risk of contracting potentially fatal vual diseases for the last three decades The author reviens here, the hazards of blood exposure and the measures that ought to be taken.

Incidence of lymphomas in head and neck region

In the present study 109 cases of Heck swellings were subjectedto F.V.A.C. examination. H vases teere found to he positive for lymphomas with 62.5% eases presenting as cervical lymphade.nopathy. Median age of presentation tints 48 years with preponderance of femulr patients. 57.2% of the patients presented in stage I of the disease.

Clinicopathological study of tumous of hypopharynx

Thirty cases of tumors of hypopharyiix were admitted in EST department ofRujendra Hospital, Patiala for ciinicopathological study. Peak age incidence of tumours was seen in 6th decade of Life. Males were affected more than females (23:7), Alcohul consumption, smoking and poor orodental hygiene were important predisposing factors responsible for the disease. Maximum number of cases the growth was seen in pyrifarm fossa (80%). Dysphagia, neck mass and throat pain were commonest symptoms. AU cases were found to be Mstologicalty squamous cell carcinoma. Most of the patients presented in advanced stage with cervical lymphnode metastasis in 60% of cases.

A study on mass hysteria (monkey men?) victims in East Delhi

During the summer month of May 2001 East Delhi came in grip of an outbreak of mass hysteria. Initial reports alleged that some monkey like creature attacked and caused injuries among number of persons. A medical board was set up to examine and find out the cause of injuries in the victims of the outbreak as a part exercise to apprehend the culprit. The study describes the sociodemographic pattern and injuries observed in these cases. Majority of victims were adult males, belonging to low socioeconomic strata and having low educational level. The incidents occurred mainly during night at the time of power failure. The type, distribution and characteristic of the injuries suggested of their accidental nature. The paper also discusses the role of forensic experts and press in such outbreak.

Conservation of wild animals by assisted reproduction and molecular marker technology

Wild animals are an integral component of the ecosystem. Their decimation due to abrupt natural calamities or due to gradual human intervention would be disastrous to the ecosystem and would alter the balance in nature between various biotic components. Such an imbalance could have an adverse effect on the ecosystem. Therefore, there is an urgent need to put an end to the ever increasing list of endangered species by undertaking both in situ and ex situ conservation using tools of modern biology, to ascertain the degree of genetic variation and reproductive competence in these animals. This review highlights the development and use of molecular markers such as microsatellites, minisatellites, mitochondrial control region, cytochrome b and MHC loci to assess the genetic variation in various Indian wild animals such as the lion, tiger, leopard and deer. The review also presents data on the semen profile of the big cats of India. Reproductive technologies such as cryopreservation of semen and artificial insemination in big cats are also highlighted.

Homicide by improvised explosive device made out of firecrackers

Explosion is a phenomenon resulting from a sudden release of energy dissipated by: (1) blast wave; (2) translocation of objects; and (3) generation of heat. There are different types of explosive devices varying from sophisticated military bombs to simple firecrackers. These are made from various kinds of explosive materials. Sophisticated bombs are used in war and military operations to kill one's enemies, while simple firecrackers are meant for expressing joy and celebration. Here, the author reports an unusual case of homicide by the manufacture of an improvised explosive device from simple firecrackers. In India, these firecrackers are widely and freely available all over the country. The case highlights the fatal hazard resulting from easy access to these potentially dangerous devices, apart from the environmental pollution produced by their large scale use at the time of festivals in this country.

Regulation and distribution of MAdCAM-1 in endothelial cells in vitro

Mucosal addressin cell adhesion molecule-1 (MAdCAM-1) is a 60-kDa endothelial cell adhesion glycoprotein that regulates lymphocyte trafficking to Peyer's patches and lymph nodes. Although it is widely agreed that MAdCAM-1 induction is involved in chronic gut inflammation, few studies have investigated regulation of MAdCAM-1 expression. We used two endothelial lines [bEND.3 (brain) and SVEC (high endothelium)] to study the signal paths that regulate MAdCAM-1 expression in response to tumor necrosis factor (TNF)-alpha using RT-PCR, blotting, adhesion, and immunofluorescence. TNF-alpha induced both MAdCAM-1 mRNA and protein in a dose- and time-dependent manner. This induction was tyrosine kinase (TK), p42/44, p38 mitogen-activated protein kinase (MAPK), and nuclear factor (NF)-kappa B/poly-ADP ribose polymerase (PARP) dependent. Because MAdCAM-1 is regulated via MAPKs, we examined mitogen/extracellular signal-regulated kinase (MEK)-1/2 activation in SVEC. We found that MEK-1/2 is activated by TNF-alpha within minutes and is dependent on TK and p42/44 MAPKs. Similarly, TNF-alpha activated NF-kappa B through TK, p42/44, p38 MAPKs, and PARP pathways in SVEC cells. MAdCAM-1 was also shown to be frequently distributed to endothelial junctions both in vitro and in vivo. Cytokines like TNF-alpha stimulate MAdCAM-1 in high endothelium via TK, p38, p42/22 MAPKs, and NF-kappa B/PARP. MAdCAM-1 expression requires NF-kappa B translocation through both direct p42/44 and indirect p38 MAPK pathways in high endothelial cells.

Ginger, fat and fibrinolysis

Administration of 50 gm of fat to 30 healthy adult volunteers decreased fibrinolytic activity from a mean of 64.20 +/- 5.31 to 52.10 +/- 3.20 units (P < 0.001). Supplementation of 5 gm of ginger powder with fatty meal not only prevented the fall in fibrinolytic activity but actually increased it significantly (P < 0.001). This fibrinolytic enhancing property is a further addition to the therapeutic potential of ginger.

Argemone mexicana poisoning: autopsy findings of two cases

Epidemic dropsy, a disease due to Argemone mexicana poisoning, is characterized by pathological accumulation of diluted lymph in body tissues and cavities. Recently, the largest epidemic of the disease in India affected Delhi and its neighboring states during the months of August-September 1998. Over 3000 persons fell ill, and more than 65 died in the state of Delhi alone. Two cases belonging to the same family died, out of the large number of cases admitted in this tertiary care teaching hospital situated in eastern part of Delhi. Autopsy findings of these two cases are presented and discussed here along with the review of toxicity due to this poisoning.