Disseminated cutaneous Mycobacterium chelonae infection in an immunocompetent host

Mycobacterium chelonae is a rare, rapidly growing, atypical acid-fast bacillus. Disseminated cutaneous infection has been reported in immunocompromised patients. We report an immunocompetent 86-year-old white woman, who presented with an 8-month history of extensive ulcerated abscess-like nodules. Mycobacterial culture confirmed M. chelonae infection and the patient was treated with a combination of clarithromycin and tobramycin. To our knowledge, this is the first reported case of spontaneous, disseminated cutaneous disease occurring in an immunocompetent patient.

Metabolic and body composition changes after six months of highly active antiretroviral therapy in northern Indian patients

This study was carried out to evaluate the metabolic and body composition changes among northern Indian patients receiving combination antiretroviral therapy (cART). We prospectively studied 68 adult patients at the All India Institute of Medical Sciences hospital, New Delhi. The CD4 count, blood pressure, anthropometry, metabolic and bioelectrical impedance data were collected prior to initiation of cART and six months later. The participants had a mean age of 35.9 years and 57 (84%) were male. Hypertension developed in 10.3%. The body mass index, waist circumference, total body fat and lean body mass increased significantly. The total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol, triglyceride and non-HDL-c increased significantly (P < 0.0001). Diabetes mellitus developed in 2.1%; metabolic syndrome in 19.1% (according to International Diabetes Federation criteria) and 25% (National Cholesterol Education Program--Adult Treatment Panel III criteria). Prolonged survival in the cART era may thus predispose these patients to adverse cardiovascular consequences. To the best of our knowledge, this is the first study of metabolic abnormalities in northern Indian HIV/AIDS patients receiving cART. Larger studies across India with long-term follow-up periods are required to confirm these preliminary findings. We also recommend that frequent biochemical monitoring should be performed in such patients.

Takotsubo cardiomyopathy: an uncommon cause of reversible heart failure

Takotsubo cardiomyopathy is increasingly being diagnosed as a cause of acute coronary syndrome in postmenopausal women. It may also present as reversible acute left heart failure with an excellent prognosis for recovery. Although rare, it may be an underdiagnosed condition in the medical intensive care units among patients admitted with non-cardiac acute conditions. Therefore, intensivists must be aware of the possibility of this condition; this can help to avoid unnecessary costly investigations and provide an early, definite prognosis.

A randomised controlled trial of low-dose misoprostol and dinoprostone vaginal pessaries for cervical priming

OBJECTIVE

We studied the efficacy of 25-microg misoprostol pessaries as either single or double dose compared with a 3-mg dinoprostone pessary for cervical priming.

DESIGN AND SETTING

A randomised controlled trial in Singapore.

POPULATION

One hundred and seventy-one women with term pregnancies and modified Bishop scores (mBS) < or =6 from 2003 to 2004.

METHOD

Patients were randomised to single misoprostol dose, double misoprostol dose or the current dinoprostone regimen.

MAIN OUTCOME MEASURES

Primary outcome was number of women who achieved favourable mBS >6 or active labour by day 2. Secondary outcomes were time interval from insertion to delivery, cardiotocographic abnormalities, delivery and neonatal outcome.

RESULTS

More women in the misoprostol double-dose group (96.6%) and dinoprostone group (93%) achieved the primary outcome compared with the single-dose group (77.8%) (P = 0.003 and P = 0.03, respectively). There was no difference in secondary outcomes. More multiparous women achieve primary outcome compared with nulliparous women (odds ratio 0.21, 95% confidence interval 0.06-0.77).

CONCLUSION

Double-dose misoprostol 25 microg is as effective as dinoprostone 3 mg inserts for cervical priming; both are more efficacious than a single-dose misoprostol pessary. Parity prognosticates the success of induction.

Effect of soybean meal substitution by different concentrations of sunflower meal on egg quality traits of white and coloured dwarf dam lines

1. The effect of soybean meal substitution by different concentrations of sunflower meal on egg quality traits of white and coloured dwarf dam lines was investigated. 2. A total of 144 dwarf hens (38 weeks of age) from the same hatch were randomly divided into 12 groups of 12 birds (4 dietary treatments x 3 replicates). 3. A 2 x 4 factorial design was used to study the effect of 2 lines (Factor A) and substitution of soybean meal (SBM) with 4 concentrations (0, 10, 15 and 20%) of sunflower meal (SFM) [Factor B] on egg quality traits of dwarf dam line hens. 4. All the diets were designed to be isocaloric (113 MJ ME/kg) and isonitrogenous (180 g/kg crude protein) The duration of the experiment was 12 weeks. 5. Analysis of variance indicated a highly significant line effect. There were non-significant effects of substitution of soybean meal with different concentrations of sunflower meal on egg quality traits except for Haugh unit. 6. White plumaged dwarf broiler breeder dam line produced significantly fewer, but larger, eggs than coloured dwarf dam line hens.

Development of quantitative-fluorescence polymerase chain reaction for the rapid prenatal diagnosis of common chromosomal aneuploidies in 1,000 samples in Singapore

INTRODUCTION

We aimed to develop a rapid quantitative-fluorescence polymerase chain reaction (QF-PCR) to detect common foetal aneuploidies in the Singapore population within 48 hours of sample collection in order to alleviate parental anxiety.

METHODS

DNA from 1,000 foetal samples (978 amniotic fluids, 14 chorion villi and eight foetal blood samples) was analysed using a QF-PCR of 19 microsatellite markers located on chromosomes 13, 18, 21, X and Y. A total of 523 samples were archived before the QF-PCR analysis (archived), while QF-PCR was performed and the results obtained within 48 hours of sample collection in the remaining 477 samples (live). The results were confirmed with their respective karyotypes.

RESULTS

In total, 47 autosomal trisomies (T) were found: 30 among the archived (three T13, 12 T18, 15 T21) and 17 among the live (four T18, 13 T21) samples. The QF-PCR results were verified with their respective karyotypes. We achieved 100 percent sensitivity (lower 95 percent confidence interval [CI], 92.8 percent) and specificity (lower 95 percent CI, 99.5 percent), and the time taken from sample collection to the obtaining of results for the 477 live samples was less than 48 hours.

CONCLUSION

Prenatal diagnostic results of common chromosomal abnormalities can be released within 48 hours of sample collection using QF-PCR. Parental anxiety is alleviated and clinical management is enhanced with this short waiting time.

Mutations affecting disulphide bonds contribute to a fairly common prevalence of F13B gene defects: results of a genetic study in 14 families with factor XIII B deficiency

Severe factor XIII (FXIII) deficiency is a rare autosomal recessive coagulation disorder affecting one in two million individuals. The aim of the present study was to screen for and analyse F13B gene defects in the German population. A total of 150 patients presenting with suspected FXIII deficiency and one patient with severe (homozygous) FXIII deficiency were screened for mutations in F13A and F13B genes. Twenty-five individuals presented with detectable heterozygous mutations, 12 of them in the F13A gene and 13 of them in the F13B gene. We report on the genotype-phenotype correlations of the individuals showing defects in the F13B gene. Direct sequencing revealed 12 unique mutations including seven missense mutations (Cys5Arg, Ile81Asn, Leu116Phe, Val217Ile, Cys316Phe, Val401Glu, Pro428Ser), two splice site mutations (IVS2-1G>C, IVS3-1G>C), two insertions (c.1155_1158dupACTT, c.1959insT) and one in-frame deletion (c.471-473delATT). Two of the missense mutations (Cys5Arg, Cys316Phe) eliminated disulphide bonds (Cys5-Cys56, Cys316-Cys358). Another three missense mutations, (Leu116Phe, Val401Glu, Pro428Ser) were located proximal to other cysteine disulphide bonds, therefore indicating that the region in and around these disulphide bonds is prone to functionally relevant mutations in the FXIII-B subunit. The present study reports on a fairly common prevalence of F13B gene defects in the German population. The regions in and around the cysteine disulphide bonds in the FXIII-B protein may be regions prone to frequent mutations.

Effect of higher dietary vitamin E concentrations on physical and biochemical characteristics of semen in Kadaknath cockerels

1. This experiment was to investigate the effects of increasing dietary vitamin E on physical and biochemical characteristics of semen in Indian reared Kadaknath (KN) cockerels. DL-alpha-Tocopherol acetate was used as the source of vitamin E. 2. A total of 135 one-day-old male KN chicks were randomly selected and divided into 9 groups with 15 chicks in each group (3 dietary treatments x 3 replicates). 3. The basal diet contained 15 IU (10 mg) vitamin E/kg and the two experimental diets were supplemented with 150 IU (100 mg) and 300 IU (200 mg) vitamin E/kg (diets T(2) and T(3), respectively). 4. Physical characteristics in terms of semen volume, sperm concentration, sperm motility and percentage live sperm did not differ significantly, whereas proportion of abnormal and dead spermatozoa were significantly lower and fertility higher in the T(2) group. 5. Biochemical characteristics in term of quantities of protein and nitric oxide (NO) did not differ significantly, whereas the quantity of glucose, acid phosphatase (ACP) and vitamin E were significantly higher in the T(2) group. 6. In contrast, the quantities of alkaline phosphatase (ALP), glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) were significantly lower in T(2) group and higher in the T(1) (control) group. 7. From this study it can be concluded that moderate supplementation of dietary vitamin E may be beneficial for physical and biochemical characteristics of semen in Indian reared KN cock.