Biologics in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic progressive disease of the joints associated with significant morbidity, deformity, and impaired quality of life. A satisfactory remission of disease is seldom achieved, so therapy is aimed at controlling joint damage and pain with preservation of joint mobility. Until recently, NSAIDs, followed by DMARDs, was considered the treatment of choice. However, many patients fail to gain a satisfactory response to DMARDs or response declines over time. Biologics such as IL-1 receptor antagonist (anakinra), and anti TNF-alpha agents (Etanercept, Infliximab, and Adalimumab) are now available. The anti TNF and IL-1 therapies exert their anti-inflammatory action by neutralizing the activities of TNF-alpha and IL-1 respectively. In contrast to older DMARDs, these agents have rapid onset of action with fewer side effects and have pronounced disease reducing activity in patients who have previously been treated with other DMARDs, when administered as monotherapy or in combination with methotrexate. They have been shown to be at least as effective as methotrexate in reducing clinical disease activity and reducing radiographic progression. Biological agents are generally well tolerated, although their long-term safety needs to be determined. Some concerns have been raised that anti TNF-alpha therapy can increase the risk of serious infections, since TNF-alpha plays an important role in host defense. In light of limitations of cost and lack of long-term safety and efficacy data, newer agents for the time being are used as second- or third-line agents in patients with active RA. The dilemma is that which patients with RA are most suitable for such therapy, since it is still not possible to accurately predict which patient with RA will develop severe disease. One alternative approach may be to limit the use in patients who can afford it, and who are at high risk of radiographic progression and disability.

Heavy metals accumulation in soils irrigated by municipal and industrial effluent

Four soil profiles have been exposed in municipal, industrial effluents and municipal wastes mixed with industrial wastes (mixed effluent) and tube well irrigated areas of Indore district of Madhya Pradesh. Soil samples were collected horizon wise and analyzed for pH, electrical conductivity (EC), organic carbon, CaCO3, clay content, cation exchange capacity (CEC), exchangeable sodium percentage (ESP) and heavy metals content viz. Fe, Mn, Zn, Cu, Cd, Cr, Co and Pb. Results showed all the heavy metals content decreased with increase in depth of soil profile. Municipal wastes / untreated sewage affected soil of Bhangarh village depicted highest content of heavy metals. The order of percentage availability of different heavy metals irrespective of the sources of irrigation is Pb>Co>Cr>Cd. However, continuous application of sewage indicated higher accumulation of heavy metals although the rate of accumulation was faster in case of industrial effluent within 2 years of irrigation. Organic carbon content had significant positive correlation with heavy metals except Cu and Zn, and negative correlation with pH and CaCO3. ESP had a negative correlation with all the metals. Zn, Mn, Cd and Co indicated significant negative correlation with the CEC of the soil. Inter-metallic correlation indicates a significant positive correlation in between Fe, Cu, Zn, Mn, Co, and Pb and among themselves.

Estrogen receptor ? expression in mice kidney shows sex differences during aging

We have used semi quantitative RT-PCR and western blotting for the analysis of expression of estrogen receptor (ER) alpha and beta mRNA and protein in the kidney of adult and old mice of both sexes. Uterus, a well-known target for estrogen action, was used for comparison. As compared to adult, the expression of both ER alpha mRNA and protein of old mice decreased in male but increased in female. However, unlike uterus, neither ERbeta mRNA nor protein could be detected in the kidney of adult or old mice. Thus the present data reveal that the expression of ERalpha in mice kidney shows sex differences during aging.

Late-onset polymyositis in a case of poikilodermatomyositis

A case of poikiloderma developed polymyositis ten years after the onset of skin changes. This rare case of poikilodermatomyositis, hitherto not reported from Asian continent, is documented.

A preliminary study on pharmacokinetics of oral indomethacin in premature infants in north India

BACKGROUND & OBJECTIVES

Patent ductus arteriosus (PDA) is a frequent complication in premature infants. Intravenous indomethacin is the standard mode of medical therapy and has been shown to be efficacious in closing the ductus. In our setup, oral indomethacin is being regularly used for medical treatment of suspected or clinically diagnosed PDA. Non-availability of the parenteral preparation and lack of information regarding the pharmacokinetic disposition of indomethacin in the premature infants in north Indian population led us to conduct this pharmacokinetic study with oral indomethacin.

METHODS

Twenty premature infants with gestational age 30.3 +/- 0.3 wk and birth weight, 1209.8 +/- 39.5 g; admitted to the neonatal unit of the Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh were enrolled in the study. Indomethacin was administered in a single oral dose of 0.2 mg/kg and blood samples were collected through an indwelling vascular catheter at 0 and 1, 2, 4, 8 and 12 h after administration of indomethacin. Plasma indomethacin concentrations were assayed by spectrofluorometric technique.

RESULTS

Large interindividual variability was observed for peak plasma concentrations (Cmax; 137.9 +/- 14.0 ng/ml), elimination half-life (t1/2 el; 21.4 +/- 1.7 h) and area under the plasma concentrations time curve (AUC0-infinity;4172 +/- 303 ng.h/ml) in these infants. Variables like birth weight, and sex did not have any sigiificant effect on indomethacin pharmacokinetics. However, the plasma t1/2 el of indomethacin was significantly (P < 0.01) larger in older infants (gestational age > 30 wk) in comparison to younger ones (gestational age < or = 30 wk). There was a negative correlation between gestational age and elimination t1/2 (r = -0.77).

INTERPRETATION & CONCLUSION

In conclusion, indomethacin pharmacokinetics showed a wide variability in premature infants. In view of these findings it can be suggested that infants of smaller gestational age are at greater risk of cumulative toxicity if more than one dose of indomethacin is given. With advancing age, metabolism as well as elimination of drug is faster that may require modification in indomethacin dose to achieve therapeutic response. These preliminary results may be of use in designing future pharmacokinetic studies of oral indomethacin in preterm neonates on a larger sample.

Construction of green fluorescent protein (GFP)-marked strains of Bradyrhizobium for ecological studies

AIM

To introduce the gfp gene encoding green fluorescent protein (GFP) into bradyrhizobia for their identification in nodules, soil and carrier-based inoculants.

METHODS AND RESULTS

Bradyrhizobium sp. strains M29 and GN7, which nodulate mungbean (Vigna radiata), were conjugated with Escherichia coli S17-1 carrying plasmid EDS 15 (a suicide plasmid carrying a promoterless gfp gene fused with Tn5). The GFP-marked strain expressed the gfp gene from a Bradyrhizobium promoter and gave green fluorescence when observed under an epifluorescent microscope or u.v. transilluminater. All the GFP-marked strains were able to nodulate mungbean and fix nitrogen. The GFP-marked bradyrhizobia were recovered at a frequency of 90-100% and 16-63% from nodules formed under sterilized and unsterilized conditions, respectively. The GFP-marked bradyrhizobia were identified from soil and from charcoal-based inoculants on the basis of green fluorescence.

CONCLUSIONS

The GFP-marked Bradyrhizobium was successfully identified on the basis of green fluorescence to study its competition and survival in the soil and in charcoal-based inoculants.

SIGNIFICANCE AND IMPACT OF THE STUDY

Introduction of the gfp gene into Bradyrhizobium provides a simple, specific and cost-effective method of strain identification for ecological studies.

Lipid Profile In Transplant Patients: A Clinical Study

15 renal transplant recipients were studied for their lipid profile. The patients were on regular post transplant follow up and had non clinical or laboratory evidence of graft dysfunction, intercurrent infection or post transplant diabetes mellitus for at least 3 months prior to the study. The mean duration of transplant was 15 ± 9.5 months (range 3-32 months). Majority (86%) were on triple immunosuppression therapy and received a mean prednisolone dose of 10.5 mg. An equal number of healthy subjects were randomly selected and studied for their lipid profile and served as control for the study group. There was no significant change in the HDL-cholesterol level as compared with controls. However, these patients showed a significantly higher LDL-cholesterol and total cholesterol levels. Further, a significant inverse correlation was observed between triglycerides and total cholesterol levels and transplant duration.

Neurenteric Cyst- Case Report

Abstract

Histoid leprosy with ENL reaction

A 23-year old man presented with firm cutaneous and subcutaneous nodules of histoid leprosy. Some of the nodules suppurated after multidrug therapy (MDT) and these nodules showed features of erythema nodosum leprosum (ENL) on histopathological examination. ENL is a rare phenomenon observed in histoid leprosy.

Analysis of different approaches for evaluation of surface energy of microbial cells by contact angle goniometry

Microbial adhesion on solid substrate is important in various fields of science. Mineral-microbe interactions alter the surface chemistry of the minerals and the adhesion of the bacterial cells to mineral surface is a prerequisite in several biobeneficiation processes. Apart from the surface charge and hydrophobic or hydrophilic character of the bacterial cells, the surface energy is a very important parameter influencing their adhesion on solid surfaces. There were many thermodynamic approaches in the literature to evaluate the cells surface energy. Although contact angle measurements with different liquids with known surface tension forms the basis in the calculation of the value of surface energy of solids, the results are different depending on the approach followed. In the present study, the surface energy of 140 bacterial and seven yeast cell surfaces has been studied following Fowkes, Equation of state, Geometric mean and Lifshitz-van der Waals acid-base (LW-AB) approaches. Two independent issues were addressed separately in our analysis. At first, the surface energy and the different components of the surface energy for microbial cells surface are examined. Secondly, the different approaches are evaluated for their internal consistency, similarities and dissimilarities. The Lifshitz-van der Waals component of surface energy for most of the microbial cells is realised to be approximately 40 mJ/m2 +/-10%. Equation of state and Geometric mean approaches do not possess any internal consistency and yield different results. The internal consistency of the LW-AB approach could be checked only by varying the apolar liquid and it evaluates coherent surface energy parameters by doing so. The electron-donor surface energy component remains exactly the same with the change of apolar liquid. This parameter could differentiate between the Gram-positive and Gram-negative bacterial cells. Gram-negative bacterial cells having higher electron-donor parameter had lower nitrogen, oxygen and phosphorous content on their cell surfaces. Among the four approaches, LW-AB was found to give the most consistent results. This approach provides more detailed information about the microbial cell surface and the electron-donor parameter differentiates different type of cell surfaces.

Intraoperative ultrasound-guided retrieval of an airgun pellet from the tongue: a case report

Real-time intraoperative ultrasonography was used to detect and facilitate removal of an airgun pellet from the tongue of a 14-year-old boy. Diagnostic ultrasound was crucial in clarifying the positional relation between the foreign body and the instrument used, enabling safe, precise and rapid retrieval during a potentially hazardous surgical operation.

Polymorphism at rDNA loci in barley and its relation with climatic variables

The variation in length of the intergenic spacer (IGS) region of the ribosomal DNA repeat unit was examined in 63 accessions of wild barley, Hordeum spontaneum, and seven accessions of cultivated barley, Hordeum vulgare. The accessions of wild barley were collected from ecologically diverse climatic and edaphic microsites in Israel, and the barley cultivars were those grown in India. Sixteen spacer-length variants (slvs) observed in the present study presumably belonged to two known rDNA loci ( Rrn1 and Rrn2). Each accession had one or more variants, which together represented the rDNA phenotype. The rDNA phenotypes of wild barley accessions were widely diverse and differed substantially from those of cultivated barley. The slv phenotypes and the corresponding alleles were shown to be largely correlated with different climatic, edaphic and ecogeographical microsites and niches (the "Evolution Canyon" at Lower Nahal Oren, Mount Carmel; and Tabigha, Eastern Upper Galilee Mountains), so that a particular rDNA phenotype of an accession could be used to predict the climate and soil to which the accession belonged. This sharp microsite ecogeographic variation in ribosomal DNA appears adaptive in nature, and is presumably driven by climatic and edaphic natural selection.

Preincubation of Mesorhizobium ciceri with flavonoids improves its nodule occupancy

Strains of M. ciceri, symbionts of chickpea (Cicer arietinum) were incubated with the flavonoids naringenin, daidzein and quercetin which have earlier been reported as inducers and inhibitors of nodABC-lacZ fusion of M. ciceri. Preincubation of M. ciceri with naringenin and daidzein (100 nmol/L) for 1 d improved the competitive ability of the inoculated strain while preincubation with quercetin decreased the nodule occupancy of inoculated strain under sterile conditions. Under non-sterile conditions induced strains of Rcd 301 and HT-6 formed by 23 and 18% more nodules, respectively, than untreated control. Quercetin-treated strains showed by 13-20% fewer nodules than untreated controls. Therefore, it is possible to regulate the competitive ability of inoculated strains by flavonoid treatment.

Epidemiologic investigations of a malaria outbreak in northern Delhi area

Epidemiologic investigations revealed a 56.7 and 13.32% slide positivity rate in febrile and afebrile malaria cases, respectively. In both cases, Plasmodium falciparum was predominant. Anopheles culicifacies resistant to dichlorodiphenyltrichloroethane and benzene hexachloride (hexachlorocyclohexane) was found breeding profusely in pools and ponds created by excavation of earth around brick kiln in the region. Furthermore, children were not found to be producing significant levels of antibodies and a large percentage of patients harbored chloroquine-resistant parasites. Also, more than 1 P. falciparum strain was present in the population. We detected 2 strains, VI and VII, of which type VI was predominant.

Isonicotinic acid hydrazide induced anagen effluvium and associated lichenoid eruption

A 32 year-old woman developed generalised lichenoid eruptions on her body followed by diffuse loss of scalp hair of the anagen effluvium type. She was receiving several anti-tubercular drugs, including rifampicin, isonicotinic acid hydrazide (INH), pyrazinamide, and ethambutol, for abdominal tuberculosis. INH, which is a leading cause of drug eruptions in the above group of drugs was withdrawn. However, the other antitubercular drugs were continued along with 40 mg of prednisolone in a single daily morning dose. The latter was discontinued slowly over a period of 10 weeks. There was complete recovery of hair loss and the regrowth started after 12 weeks of alopecia. Such anagen effluvium with lichenoid eruption following INH therapy has not been observed previously. The complete recovery from anagen effluvium is difficult to explain, but it could have been because of the early initiation of corticosteroid.

Release of iron from ferritin by metabolites of benzene and superoxide radical generating agents

The release of iron from ferritin in the presence of benzene metabolites, viz. phenol (P), catechol (CT), hydroquinone (HQ) and superoxide radical generating compounds, viz. pyrogallol (PL), phloroglucinol (PG), phenylhydrazine (PH) or phenylenediamine (PD) was studied in acetate buffer, pH 5.6. Monitoring the formation of the iron-ferrozine complex quantitated the release of iron from ferritin. The presence of P (125 microM) did not result in the release of iron from ferritin, whereas the same concentration of CT, HQ, PL, PH or PD resulted in the release of significant amounts of iron from ferritin and a marginal amount of iron in the presence of PG, CT, HQ, PL, PH or PD concentration and time-dependent increase in iron release from ferritin were observed although the increase was not linear as a function of time and concentration of the compounds studied. The presence of superoxide dismutase inhibited significantly the release of iron from ferritin by CT, HQ, PL, PH or PD. The iron released from ferritin by CT, HQ, PL, PH or PD enhanced lipid peroxidation in rat brain homogenate and released aldehydic products from bleomycin-dependent degradation of DNA and also caused single strand nicks to pUC18 DNA. These studies indicate that CT and HQ, the two principal polyphenolic metabolites of benzene and PL, PH or PD, the superoxide radical generating compounds were capable of reducing ferric iron from ferritin and also mobilizing and releasing iron from ferritin core. The release of iron from ferritin by these compounds is a result of direct reduction of ferritin iron by electron transfer and also reduction via superoxide radical. The release of iron from ferritin by CT and HQ may have toxicological implications in relation to benzene toxicity. The release of iron by superoxide radical generating agents suggests that oxidative stress may play a role as this could lead to disruption of intracellular iron homeostasis.

A theoretical study of transition metal complexes of C60 and C70 and their ring-opened alternatives

Ring opened structures of C60 and C70 are shown to be stabilized by complexation with transition metal fragments of the form CnHnM, where n = 3 to 6 and M = Cr, Mn, Fe, Co, and Rh. The ring opening of C60 and C70 is compared with the reverse process of the well-known catalytic conversion of acetylene into benzene. Calculations at the semi-empirical PM3(tm) level show that the 6-membered ring in C60 and C70 can be opened up in different ways through complexation with transition metal fragment. The mode of ring opening depends on the number of external 5- and 6-membered rings around the 6-membered ring being cleaved. The structures and energetics of the various ring-opened structures are discussed.

Mechanism of migration of the trimethylsilyl group during reactions of methoxy[(trimethylsilyl)ethoxy]carbene with N-phenylmaleimide and C(60)

A novel migration of the trimethylsilyl group during reaction of methoxy[(trimethylsilyl)ethoxy]carbene with N-phenylmaleimide (NPM) and with C(60), reported earlier, was examined by means of deuterium labeling of the carbene. For the NPM case it was found that the CD(2)CH(2)SiMe(3) group, initially bound to oxygen, became the CH(2)CD(2)SiMe(3) group bound to carbon in the end product. Not only had the trimethylsilylethyl group moved from oxygen to carbon, but the TMS group had also migrated 1,2 along the ethyl chain. For the C(60) case, complete scrambling of the CD(2) group was observed, strongly implying the involvement of a silacyclopropane carbocation responsible for product formation. The labeling study supports the mechanism that was tentatively advanced earlier for addition to NPM and one of the possibilities suggested for addition to C(60).

Merits of performing coronary artery by-pass grafts on the beating heart

A retrospective study of 1006 patients was undertaken to evaluate the benefit of a change of strategy in performing coronary artery by-pass grafting surgery. Group A consisted of 500 patients who were consecutively operated on cardiopulmonary by-pass and group B consisted of 506 patients who were consecutively operated on using "off pump" techniques. Pre-operative risk profile in both groups were similar as was as in the operating time. There was distinct benefit in amount of homologous transfusion, period of ICU stay, increased usage of radial artery conduit and improvement in transoesophageal echocardiography assessment of ischaemic mitral incompetence immediately after revascularisation in off pump (group B). Though there was a lower mortality in group B ie, 3/506 vis-a-vis 10/500 in group A this is not of statistical significance. Improvement in left ventricular ejection fraction >5.0% occurred more frequently in one month follow-up visits of group B patients. Period of return to active life was also shorter (28 versus 56 days). Based on observations, we conclude that there is a distinct benefit in avoiding cardiopulmonary by-pass while performing coronary artery by-pass grafting.

Sentinel node localization in oral cavity and oropharynx squamous cell cancer

OBJECTIVE

To evaluate the feasibility and predictive ability of the sentinel node localization technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks.

DESIGN

Prospective, efficacy study comparing the histopathologic status of the sentinel node with that of the remaining neck dissection specimen.

SETTING

Tertiary referral center.

PATIENTS

Patients with T1 or T2 disease and clinically negative necks were eligible for the study. Nine previously untreated patients with oral cavity or oropharyngeal squamous cell carcinoma were enrolled in the study.

INTERVENTIONS

Unfiltered technetium Tc 99m sulfur colloid injections of the primary tumor and lymphoscintigraphy were performed on the day before surgery. Intraoperatively, the sentinel node(s) was localized with a gamma probe and removed after tumor resection and before neck dissection.

MAIN OUTCOME MEASURES

The primary outcome was the negative predictive value of the histopathologic status of the sentinel node for predicting cervical metastases.

RESULTS

Sentinel nodes were identified in 9 previously untreated patients. In 5 patients, there were no positive nodes. In 4 patients, the sentinel nodes were the only histopathologically positive nodes. In previously untreated patients, the sentinel node technique had a negative predictive value of 100% for cervical metastasis.

CONCLUSIONS

Our preliminary investigation shows that sentinel node localization is technically feasible in head and neck surgery and is predictive of cervical metastasis. The sentinel node technique has the potential to decrease the number of neck dissections performed in clinically negative necks, thus reducing the associated morbidity for patients in this group.

Epidemic dropsy: a study of cutaneous manifestations with histopathological correlation

Clinical and histopathological features of epidemic dropsy were studied in 19 patients. Bilateral pitting pedal oedema, erythrocyanosis and tachycardia without fever were the predominant clinical features. Histology revealed deposition of hyaline material on the walls of dermal blood vessels.

Bacillary angiomatosis in an immune-competent patient

Bacillary angiomatosis is reported in a 65-year-old man. He was immunocompetent and the lesions subsided following treatment with oral erythromycin.