Incidental lymphadenopathy in renal transplantation

INTRODUCTION

Iliac lymphadenectomy is performed to provide anastomotic access during the vascular implantation procedure in renal transplantation. Iliac lymph nodes (LNs) are often enlarged, but there are no standardised guidelines for the management of incidentally enlarged LNs during transplantation. We aimed to evaluate histological findings of LNs sent for examination at our unit.

METHODS

Patients were evaluated in two distinct date cycles. In the first cycle, lymphadenectomy and histological assessment were performed at the discretion of the transplanting surgeon. In the second cycle, all incidentally enlarged LNs were sent for histological assessment, regardless of size.

RESULTS

In the first cycle (n = 76), 11 patients (14.47%) had incidentally enlarged iliac LNs on lymphadenectomy and histology showed only reactive changes. In the second cycle (n = 165), eight patients (4.85%) had incidentally enlarged LNs on lymphadenectomy. One patient was found to have mature B cell chronic lymphocytic leukaemia. The patient was referred to haematology and a "watch and wait" approach was taken, with the patient still alive at last follow-up (511 days post-transplantation).

DISCUSSION

There are currently no published guidelines on the management of incidentally enlarged iliac LNs during transplantation. Current literature suggests that clinically significant lymphadenopathy needs to be investigated in all patients. Based on our centre's experience of a 5.26% (1 in 19) positive pathological LN sampling, we recommend that all incidental LNs with suspicious features and/or that are greater than 10mm in diameter should be considered for histological, microbiological and molecular assessment as appropriate.

Graph Embedded Intuitionistic Fuzzy Random Vector Functional Link Neural Network for Class Imbalance Learning

The domain of machine learning is confronted with a crucial research area known as class imbalance (CI) learning, which presents considerable hurdles in the precise classification of minority classes. This issue can result in biased models where the majority class takes precedence in the training process, leading to the underrepresentation of the minority class. The random vector functional link (RVFL) network is a widely used and effective learning model for classification due to its good generalization performance and efficiency. However, it suffers when dealing with imbalanced datasets. To overcome this limitation, we propose a novel graph-embedded intuitionistic fuzzy RVFL for CI learning (GE-IFRVFL-CIL) model incorporating a weighting mechanism to handle imbalanced datasets. The proposed GE-IFRVFL-CIL model offers a plethora of benefits: 1) leveraging graph embedding (GE) to preserve the inherent topological structure of the datasets; 2) employing intuitionistic fuzzy (IF) theory to handle uncertainty and imprecision in the data; and 3) the most important, it tackles CI learning. The amalgamation of a weighting scheme, GE, and IF sets leads to the superior performance of the proposed models on KEEL benchmark imbalanced datasets with and without Gaussian noise. Furthermore, we implemented the proposed GE-IFRVFL-CIL on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset and achieved promising results, demonstrating the model's effectiveness in real-world applications. The proposed GE-IFRVFL-CIL model offers a promising solution to address the CI issue, mitigates the detrimental effect of noise and outliers, and preserves the inherent geometrical structures of the dataset.

Graph embedded ensemble deep randomized network for diagnosis of Alzheimer's disease

Randomized shallow/deep neural networks with closed form solution avoid the shortcomings that exist in the back propagation (BP) based trained neural networks. Ensemble deep random vector functional link (edRVFL) network utilize the strength of two growing fields, i.e., deep learning and ensemble learning. However, edRVFL model doesn't consider the geometrical relationship of the data while calculating the final output parameters corresponding to each layer considered as base model. In the literature, graph embedded frameworks have been successfully used to describe the geometrical relationship within data. In this paper, we propose an extended graph embedded RVFL (EGERVFL) model that, unlike standard RVFL, employs both intrinsic and penalty subspace learning (SL) criteria under the graph embedded framework in its optimization process to calculate the model's output parameters. The proposed shallow EGERVFL model has only single hidden layer and hence, has less representation learning. Therefore, we further develop an ensemble deep EGERVFL (edEGERVFL) model that can be considered a variant of edRVFL model. Unlike edRVFL, the proposed edEGERVFL model solves graph embedded based optimization problem in each layer and hence, has better generalization performance than edRVFL model. We evaluated the proposed approaches for the diagnosis of Alzheimer's disease and furthermore on UCI datasets. The experimental results demonstrate that the proposed models perform better than baseline models. The source code of the proposed models is available at https://github.com/mtanveer1/.

O092 Fibrin-based haemostatic agents for reducing blood loss in adult liver resection: a meta-analysis

Introduction

Liver resection can be associated with significant perioperative bleeding. Fibrin based haemostatic agents (FBHAs) are bioabsorbable topical haemostatic agents used to enhance haemostasis and reduce blood loss. We performed a systematic review and meta-analysis, comparing FBHAs with the standard of care and no topical application (SoC), and comparing FBHAs with non-fibrin-based haemostatic agents (NFHAs) to evaluate their efficacy in reducing blood loss and improving perioperative outcomes.

Method

The Cochrane Hepato-Biliary Specialised Register was searched to identify (quasi-) RCTs to include in our meta-analysis. Two authors independently reviewed each study. Primary outcomes were haemostatic efficacy (defined as haemostasis within 4 or 5 minutes post application), adverse events and perioperative mortality (within 30-days of surgery). Statistical analyses were performed using the random effects model and results expressed as odds ratio (OR) with 95% confidence intervals.

Result

Twenty-seven RCTs (3736 participants) were included in our analysis. FBHAs were found to have superior haemostatic efficacy compared to NFHAs (OR 4.03; 1.73–9.36, p=0.001), and were superior to SoC (OR 13.59; 4.06–45.47, p<0.0001). Incidence of adverse events and perioperative mortality was no different when comparing FBHAs with SoC or NFHAs. No differences were detected when testing for post-operative bile leakage, intra-abdominal collections, volume of abdominal drain output, post-operative transfusion requirements, reoperation rates and length of stay (all p>0.05).

Conclusion

FBHAs appear superior to SoC and NFHAs in achieving haemostasis within 4–5 minutes post-application, however this does not translate into improved post-operative outcomes. FBHAs are not justified for routine use based on the available evidence.

A case report of an angiomyxoma in the liver

Angiomyxomas are uncommon myxoid tumours arising most commonly from the pelvis. A 46-year-old woman with a history of polycystic kidney disease presented asymptomatically for surveillance ultrasonography; changes were noted in the size and morphology of her liver cysts. Subsequent radiological assessment displayed features suspicious of malignancy and a right hemihepatectomy was performed with curative intent. Pathological examination of the resected specimen found histology consistent with an angiomyxoma arising primarily from the liver parenchyma. Follow-up review of the patient has been uneventful with annual imaging showing no evidence of recurrence. Angiomyxomas do not characteristically invade other tissues. However, any liver lesion displaying suspicious features of malignancy should be resected in the absence of disseminated disease.

Is nitric oxide level affected in postmenopausal women with hypothyroidism?

AIM

To analyze serum levels of nitric oxide (NO), an indicator of cardiovascular health, in post-menopausal females with and without hypothyroidism.

METHODS

NO was analyzed colorimetrically in 30 newly diagnosed hypothyroid postmenopausal females and 30 postmenopausal females with normal thyroid profile. Results were compared and subjected to appropriate statistical analysis.

RESULTS

The levels of serum NO were found to be significantly decreased in postmenopausal females with hypothyroidism as compared to the levels in those with normal thyroid profile (P value < 0.05). A negative correlation of NO was observed with thyroid stimulating hormone whereas a positive correlation of NO was observed with free T3 (FT3), free T4 (FT4), T3 and T4 though it was statistically significant only for FT4 among postmenopausal females with hypothyroidism.

CONCLUSION

Postmenopausal hypothyroid females may be at a risk of compromised cardiovascular health as indicated by low NO levels. Regular monitoring and risk assessment is essential for timely intervention.

Spectrophotometric determination of iron(III) dimethyldithiocarbamate (ferbam)

A spectrophotometric method was developed for the determination of ferbam (iron(III) dimethyldithiocarbamate) by converting it into an iron-phenanthroline complex, which was then absorbed on microcystalline naphthalene in the presence of tetraphenylborate, and the absorbance was measured at 515 nm against a reagent blank. The molar absorptivity of the complex was 1.2 x 10(4)l mol(-1)cm(-1). Ten replicate analyses of a sample solution containing 150 mug of ferbam gave a relative standard deviation of 0.84%. Beer's law was obeyed over the concentration range 22.4-372.9 mug of ferbam. The effects of various factors such as reagent concentration and naphthalene, shaking time and diverse ions were studied in detail. The method is sensitive and selective and can be applied to the direct determination of ferbam in commercial samples and in mixtures containing various other dithiocarbamates (e.g. ziram, zineb and maneb) in foodstuffs.

A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff

Revision arthroplasty of the hip is expensive owing to the increased cost of pre-operative investigations, surgical implants and instrumentation, protracted hospital stay and drugs. We compared the costs of performing this surgery for aseptic loosening, dislocation, deep infection and peri-prosthetic fracture. Clinical, demographic and economic data were obtained for 305 consecutive revision total hip replacements in 286 patients performed at a tertiary referral centre between 1999 and 2008. The mean total costs for revision surgery in aseptic cases (n = 194) were £11 897 (sd 4629), for septic revision (n = 76) £21 937 (sd 10 965), for peri-prosthetic fracture (n = 24) £18 185 (sd 9124), and for dislocation (n = 11) £10 893 (sd 5476). Surgery for deep infection and peri-prosthetic fracture was associated with longer operating times, increased blood loss and an increase in complications compared to revisions for aseptic loosening. Total inpatient stay was also significantly longer on average (p < 0.001). Financial costs vary significantly by indication, which is not reflected in current National Health Service tariffs.

Clinical testing of ulnar collateral ligament injuries of the thumb

The diagnosis of complete tears of the ulnar collateral ligament of the thumb metacarpophalangeal (MP) joint depends on demonstration of excessive laxity of the ligament, but there is controversy on whether laxity greater than a certain cut-off value or laxity greater than the opposite thumb is the criterion for diagnosis. We examined 200 thumbs of 100 normal individuals in extension and in 30 degrees of flexion. In 34% of subjects there was a difference of 10 degrees or more between right and left thumbs in extension, and 12% had a difference of at least 15 degrees. In flexion, 22% of thumbs differed by 10 degrees or more and 3% by 15 degrees or more. Comparison with the uninjured contralateral thumb is unreliable in many individuals. We recommend the lack of a definite end point on stress examination as indicating complete rupture of the ulnar collateral ligament.

Ossified cephalhematoma

Ossified cephalhematoma is a rare clinical entity and a pathological curiosity. Even though cephalhematoma is frequently encountered, ossified cephalhematoma is seen only sporadically and is restricted to only few case reports in the literature. Its pathogenesis is unclear, and the clinical course is different in neonates and juveniles. The risk factors are known, but why it gets ossified in some cases is not understood. We report a case of ossified cephalhematoma which developed in a 10-week-old male child in the right parietal region and discuss its possible pathogenesis.

Distal radioulnar joint dislocation in association with elbow injuries

Traumatic distal radioulnar joint (DRUJ) dislocation with or without an associated fracture is a rare injury. When coupled with a radial head fracture this is commonly known as the Essex-Lopresti injury. We report two cases of elbow dislocation with ipsilateral radial neck fractures and associated true DRUJ dislocations. This has not been previously described in the literature. In elbow injuries with wrist involvement, symptoms in the latter may be subtle. Due to inadequate examination of the affected joint, poor initial radiographic views, and general rarity of this injury, distal radioulnar joint dislocations are frequently missed. We hope our experience illustrates the need to examine thoroughly the joint above and below the injured site, and to be aware of the potential for DRUJ instability in all patients with elbow injuries.

Renal biopsy findings in the kingdom of bahrain: a 13-year retrospective study

Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Hence, it is important to recognize the pattern of these diseases in any given geographical area. A total of 498 renal biopsies performed on patients with proteinuria, hematuria and mild to moderate renal impairment during a period of 13 years (between January 1990 and December 2002) at the Salmaniya Medical Complex (a tertiary care hospital of the Kingdom of Bahrain), were reviewed and categorized. Primary glomerular disease accounted for two-third of the glomerular diseases, which in turn constituted 44.8% of all renal biopsies. The most common histological lesion was minimal change disease (30%). Focal and segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary glomerular disease comprised 33.6% of glomerular diseases (22.7% of all the renal biopsies) with lupus nephritis forming the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies constituted 7.2% of all the biopsies. The results of this analysis were compared with surveys from other parts of the World.

Scaphoid views: a need for standardisation

AIMS

Several views are needed to visualise the scaphoid. These are routinely called 'scaphoid views'. The authors believe that asking for scaphoid views from the radiology department often leads to a wide variety and number of radiographic views being taken.

METHODS

50 radiographers were asked which and how many views of the scaphoid they would take, in the acute setting and then in the out-patient department.

RESULTS

We found a wide variation in the descriptive terms used by radiographers for particular views. There was also little agreement on how many and which radiographic views to take when asked for 'scaphoid views'.

CONCLUSIONS

Not only is there complete lack of agreement on what 'scaphoid views' should be, it was also discovered that there was little agreement on the nomenclature of the individual views themselves. Loss of information can result from the wrong views being taken and unnecessary radiation exposure. We recommend five particular views, which together visualise all areas of the scaphoid.

The spectrum of glomerular diseases in the kingdom of bahrain: An epidemiological study based on renal biopsy interpretation

Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Hence it is important to recognize the glomerular disease pattern in any given geographical area to understand the pathobiology in the region as well as the incidence and progression of the disorder. A total of 498 renal biopsies were performed on patients with proteinuria, hematuria, and mild to moderate renal impairment during a period of 13 years (between January 1990 and December 2002) at a tertiary care hospital. Primary glomerular disease accounted for two-thirds of the glomerular diseases, which was 44.8% of all renal biopsies. The most common histological lesion was minimal change disease (30%). Focal segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary glomerular disease included 33.6% of glomerular diseases with 22.7% with lupus nephritis as the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies, whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies, which constituted 7.2% of all the tissues. The results of this analysis were compared with surveys from other parts of the world.

Oesophageal cancer in Bahrain

ABSTRACT Data from all 148 cases of oesophageal cancer in Bahrain during 1952-99 were analysed according to patient sex and age and site and histological pattern of tumour, and compared with other Gulf countries. In Bahrain, oesophageal cancer accounted for 2.6% of malignant neoplasms. The female:male ratio was 1.8:1, and the majority of patients were > or =51 years and < or =70 years of age. The lower and upper third of the oesophagus were the most and least frequently involved sites, respectively. Squamous carcinoma (males) and adenocarcinoma (females) were the main histological types. There is varying consistency between these data and those of other Gulf countries having similar anthropological and demographic profiles. A prospective study may help to better understand the aetiology of the disease and inform preventive policies.

Alpha-1 antitrypsin deficiency panniculitis

A lady presented with multiple, tender discharging noduloulcerative lesions on the abdomen, following laparoscopic cholecystectomy. Histopathological features were suggestive of panniculitis. Screening of the serum for alpha-1 antitrypsin levels revealed a partial deficiency.

Benign rheumatoid nodules

Rheumatoid nodules occur usually in advanced seropositive rheumatoid arthritis, signifying poor prognosis. However rarely rheumatoid nodules can be encountered in patients with no antecedent evidence of arthritis. Herein a case of an arthritic benign rheumatoid nodules is described.

A new sensitive method for the spectrophotometric determination of molybdenum using 3-hydroxy-2-(2'-thienyl)-4H-chromen-4-one

A spectrophotometric method has been developed for the determination of Molybdenum (VI) using 3-hydroxy-2-(2'-thienyl)-4H-chromen-4-one as a complexing agent. The complex formed was dissolved in water in the presence of Triton X-100 and exhibits an absorption maximum at 410 nm. A large number of metal ions like Co(II), Ni(II), Mn(II), Cr(III), Zn(II), Cu(II), Hg(II), Bi(III), Fe(II), Fe(III), Zr(IV), V(V) can be tolerated at an appreciable concentrations. Molar absorptivity and Sandell's sensitivity of the method is 2.80 x 10(5) l mol-1cm-1 and 3.42 x 10(-4) micrograms cm-2, respectively. Beer's law is obeyed in the concentration range of 0.01-0.4 ppm Mo(VI). Aliquots containing 0.2 ppm of Mo(VI) give a mean absorbance of 0.56 with a relative standard deviation of 1.3%.

Effects of a second intron on recombinant MFG retroviral vector

The retroviral vectors based on an MFG-type backbone have superior expression characteristics, in part, due to the presence of the retroviral chimeric intron (MFG intron). We tested the hypothesis that inclusion of a second intron in MFG vectors may influence packaging and/or LTR-driven transgene expression. We constructed two MFG retroviral vectors, MFG/hFIXc and MFG/hFIXm2, containing human factor IX (hFIX) cDNA without and with a 0.3-kb hFIX intron, respectively. When tested with primary mouse myoblasts or HepG2 cells in culture for transient expression activity, pMFG/hFIXm2 plasmid produced two-to-three fold higher hFIX than pMFG/hFIXc. These vectors produced equivalent retroviral titers from packaging cells. In transduced cells, the splicing of the MFG intron in the retroviral transcripts occurred at a similar efficiency; however, MFG/hFIXc virus gave two-fold higher hFIX expression than that of the MFG/hFIXm2 viral infection. Analyses of MFG/hFIXm2 virion RNA and transduced cell genomic DNA suggested that, although the hFIX intron containing viral RNA are packaged, these viruses fail to integrate their transgenes into the genome of transduced cells, suggesting a block at the reverse transcription and/or integration steps. Similar results were also obtained with the prototype vectors, LIXcSN and LIXm2SN, lacking the MFG intron. Together, these results suggest that a hFIX cDNA sequence in the retroviral vectors performs better over hFIX intron-containing minigene.

Column preconcentration of trace manganese with the ion pair of 2-nitroso-1-naphthol-4-sulfonic acid tetradecyldimethylbenzyl-ammonium chloride supported on naphthalene and determination by derivative spectrophotometry

A column preconcentration method has been developed for the determination of trace amounts of manganese by preconcentration on 2-nitroso-1-naphthol-4-sulfonic acid (nitroso-S)-tetradecyldimethylbenzylammonium (TDBA) naphthalene as an adsorbent using a simple funnel tipped glass tube. Manganese reacts with nitroso-S to form a water soluble brown colored chelate anion. The chelate anion forms a water insoluble Mn-Nitroso-S-TDBA ion pair on naphthalene packed in a column in the pH range 9.6-10.5 at a flow rate of 1-2 ml/min. The solid mass consisting of manganese complex and naphthalene is dissolved in 5 ml of dimethylformamide (DMF) and the metal determined by second derivative spectrophotometry. The calibration curve is linear in the concentration range 0.25-35.0 micrograms of Mn in 5 ml of the final DMF solution. Eight replicate determinations of 25 micrograms of standard manganese solution give a mean peak height of 4.0 with a correlation coefficient of 0.9995 and relative standard deviation of +/- 1.1%. The sensitivity was calculated to be 0.502(d2 A/d lambda 2)/microgram ml-1 from the slope of the calibration curve. The detection limit was 0.020 microgram ml-1 for manganese at the minimum instrumental settings (signal to noise ratio = 2). Various parameters effecting the method such as the effect of pH, volume of aqueous phase and interference of a number of metal ions on the determination of manganese have been evaluated to optimize the conditions for its determination in standard alloys and biological samples.

Direct spectrophotometric determination of ferbam (Iron(III) dimethyldithiocarbamate) in commercial sample and wheat grains using 4,7-diphenyl-1,10-phenanthroline

A procedure has been developed for the determination of iron(III) dimethyldithiocarbamate by converting it into the iron(II)-bathophenanthroline complex, which is then dissolved in acetone-water (1:1), and the absorbance is measured at 534 nm against a reagent blank. Beer's law is obeyed over the concentration range 0.5-20 microg x mL(-1) in the final solution. The method is sensitive and highly selective and is used for the direct determination of ferbam in a commercial sample and in mixtures with various dithiocarbamates (ziram, zineb, maneb, etc.) and from wheat grains.

Spectrophotometric determination of ferbam [iron(III) dimethyl dithiocarbamate] in commercial sample and wheat grains after extraction of its bathophenanthroline tetraphenylborate complex into molten naphthalene

A procedure has been developed for the determination of iron(III) dimethyldithiocarbamate by converting it into a iron(III)-bathophenanthroline-tetraphenylborate complex, which was then extracted into molten naphthalene, and the absorbance was measured at 534 nm against a reagent blank. Beer's law is obeyed over the concentration range 0.4-20 microg mL(-)(1) in final solution. The method is sensitive and highly selective and is applied for the determination of ferbam in a commercial sample, in mixtures with various dithiocarbamates (ziram, zineb, maneb, etc.), and from wheat grains.

Simple and sensitive spectrophotometric determination of ziram, zineb and ferbam in commercial samples and foodstuffs using phenylfluorone

A procedure has been developed for the determination of ziram, zineb and ferbam dithiocarbamate pesticides by converting ziram and zineb into a zinc-phenylfluorone complex and ferbam into an iron phenylfluorone complex, which are then dissolved in water in the presence of cetylpyridinium bromide and pyridine as a surfactant. The method is sensitive, highly selective and can be used for the determination of ziram, zineb and ferbam in commercial samples and in foodstuffs.

Determination of the fungicide ferbam in wheat grains after adsorption onto microcrystalline naphthalene

A procedure was developed for the determination of iron(III) dimethyldithiocarbamate by converting it into iron(II)-bathophenanthroline-tetraphenylborate complex, which was then adsorbed onto microcrystalline naphthalene. The absorbance was measured at 534 nm against a reagent blank. Beer's Law was obeyed over the concentration range of 0.4-20 microg mL in final solution. Ten replicate determinations on 70 microg ferbam solutions gave a mean absorbance of 0.36, with a relative standard deviation of 0.91%. The method is sensitive and highly selective. It was applied for the determination of ferbam in a commercial sample and in mixtures with various dithiocarbamates (ziram, zineb, maneb) and wheat grains.

Capillary electrophoretic determination of dithiocarbamates and ethyl xanthate

A simple and sensitive capillary electrophoretic method was developed for the separation and determination of sodium methyldithiocarbamate (metham), manganese ethylenebisdithiocarbamate (maneb) and ethyl xanthate in boric acid buffer by direct UV absorbance detection at lambda = 254 nm. The separation is dependent on pH and nature of the buffer. The detection limits (S/N = 3) are 1.7 x 10(-6) mol/L for ethyl xanthate, 1.3 x 10(-6) mol/L for metham and 2.1 x 10(-6) mol/L for maneb. The method has been successfully applied to the analysis of wheat samples spiked with maneb and in a commercial sample.

Spectrophotometric determination of ferbam (iron(III) dimethyldithiocarbamate) in commercial sample and wheat grains using 4,7-diphenyl-1,10-phenanthroline after extraction into mesityl oxide

A procedure has been developed for the determination of iron(III) dimethyldithiocarbamate by converting it into iron(II)-bathophenanthroline complex, which is then extracted into mesityl oxide in the presence of potassium perchlorate. The absorbance is then measured at 534 nm against a reagent blank. Beer's law is obeyed over the concentration range 0.5-20 microg ml(-1) in the final solution. The method is sensitive, highly selective and can be used for the determination of ferbam in a commercial sample, and in mixtures with various dithiocarbamates (ziram, zineb, maneb, etc.) and in wheat grains.

Kinetics of recombinant adeno-associated virus-mediated gene transfer

Recombinant adeno-associated virus (rAAV) vectors have been shown to be useful for efficient gene delivery to a variety of dividing and nondividing cells. Mechanisms responsible for the long-term, persistent expression of the rAAV transgene are not well understood. In this study we investigated the kinetics of rAAV-mediated human factor IX (hFIX) gene transfer into human primary myoblasts and myotubes. Transduction of both myoblasts and myotubes occured with a similar and high efficiency. After 3 to 4 weeks of transduction, rAAV with a cytomegalovirus (CMV) promoter showed 10- to 15-fold higher expression than that with a muscle-specific creatine kinase enhancer linked to beta-actin promoter. Factor IX expression from transduced myoblasts as well as myotubes reached levels as high as approximately 2 microgram of hFIX/10(6) cells/day. Southern blot analyses of high-molecular-weight (HMW) cellular genomic and Hirt DNAs isolated from rAAV/CMVhFIXm1-transduced cells showed that the conversion of single-stranded vector genomes to double-stranded DNA forms, but not the level of the integrated forms in HMW DNA, correlated with increasing expression of the transgene. Together, these results indicate that rAAV can transduce both proliferating and terminally differentiated muscle cells at about the same efficiency, that expression of transgenes increases linearly over their lifetime with no initial lag phase, and that increasing expression correlates with the appearance of double-stranded episomal rAAV genomes. Evidence showing that the rAAV virions can copackage hFIX, presumably nonspecifically, was also obtained.

Evidence from a Ghanaian population of known African descent to support the proposition that hemochromatosis is a Caucasian disorder

Mutations in the HFE gene on chromosome 6 are believed to cause the iron overload disorder hemochromatosis, the most common single gene disorder in northern Europeans. Two mutations have been described previously: C282Y, with an allele frequency of between 3% and 10% in the caucasian population, and H63D, which has an allele frequency of 16%. Published data shows that C282Y appears to be causative in the homozygous state, while the frequency of H63D/C282Y compound heterozygotes is much greater than expected in patient groups. There also appears to be a slightly elevated risk for H63D homozygotes. Hemochromatosis has been thought to be primarily a caucasian disorder. We have studied 97 healthy, black Ghanaian subjects, whose parents and grandparents were also African, to find the frequency of the two mutations. C282Y was absent, while H63D occurred in 2 individuals. These differences are significant at the 0.05 and 0.001 levels, respectively. The prevalence of H63D homozygotes in this population at 1 in 10,000 is clearly of no use in studying the effect of this genotype on phenotype. However, this study suggests an absence of the C282Y mutation in African populations, and the possibility that other populations might provide different genotypes and hence an analysis of H63D risk. A possible heterozygote advantage for the mutation is discussed.

Can warfarin randomized trials be reproduced in 'real life'? Adherence to warfarin guidelines for intensity of anticoagulation in a university-based warfarin clinic

BACKGROUND

Subjects in clinical trials may benefit from the increased attention and specific focus of the trial, thereby limiting the external validity of clinical trial results to clinical practice. Our study evaluated adherence to guidelines for intensity of anticoagulation in a large, university-based warfarin clinic to assess the generalizability of randomized clinical trials of warfarin efficacy to clinical practice.

METHODS

We reviewed anticoagulation clinic records of 480 patients observed for up to 2 years to determine the amount of time anticoagulation was within the recommended therapeutic range.

RESULTS

The most common indication for warfarin use was atrial arrhythmia (51.5%). Overall, anticoagulation was within the intended international normalized ratio (INR) target range on 57.8% of treatment days. Nontherapeutic treatment days were due more commonly to subtherapeutic INR values (27.6+/-25.7%) than supratherapeutic INR values (14.9+/-17.0%). This pattern was seen across all warfarin indications.

CONCLUSION

These data are comparable to those reported from large randomized trials and thus support the generalizability of clinical trials of long-term warfarin anticoagulation to clinical practice.

Capillary electrophoretic determination of ferric dimethyldithiocarbamate as iron(III) chelate of EDTA

A simple and sensitive capillary electrophoretic method with UV detection has been developed for the determination of Ferbam (ferric dimethyldithiocarbamate) in boric acid buffer after its acidic decomposition and complexation with EDTA as Fe-EDTA- complex. The determination is dependent on the pH and the nature of the buffer solutions. In this method the detection limit (S/N = 3) is 1.8 x 10(-6) mol/L (0.7 mg/kg) of Ferbam. The relative standard deviation for the analysis of 50 microg/ml was found to be 2.9%. The method was successfully applied for the analysis of wheat grain samples spiked with Ferbam. The applicability of capillary electrophoresis as a useful tool for the analysis of Ferbam is demonstrated.

A review of capillary electrophoretic separations and their studies by nuclear magnetic resonance

Capillary electrophoresis as a microvolume separation technique is receiving increased recognition for its use in the separation of inorganic and organic compounds due to its short analysis time and small sample volume in the nanoliter and picoliter ranges. The combination of capillary electrophoresis, one of the most-often employed chromatographic separation techniques, and studies by nuclear magnetic resonance (NMR) spectroscopy is finding an increased number of applications in pharmaceutical, biomedical, and polymer research. This paper discusses the applications of capillary electrophoresis for the separation of various analytes and their studies by NMR.

A study of dermatological disorders in geriatric age group

A total of 320 patients of more than 60 years of age were studied for dermatological changes with aging. The male female ratio of patients was 3:1. Majority of cases (60.6%) were between 60-65 years of age. Pruritus was present in 37.5% cases, wrinkles in 82.1%, senile lentigenes in 57.8%, seborrhoeic keratosis in 48.8%, cherry angioma in 48.1%, idiopathic guttate hypomelanosis in 43%, skin tags in 37%, xerosis in 28%, comedones in 19%, infection and infestation in 40%, eczematous disorders in 36.9%, papulosquamous disorders in 10%, metabolic disorders in 16%, pigmentary disorders in 8.7%, keratinisation disorders in 4.1%, vesiculobullous disorders in 2.8% and associated systemic disorders in 49.7% cases.

Progressive neurological symptoms in a diabetic patient

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Comparative evaluation of antimicrobial activity of polyvinylpyrrolidone (PVP)-iodine versus topical antibiotics in cataract surgery

Comparative evaluation of polyvinylpyrrolidone (PVP)-iodine versus topical broad-spectrum antibiotics for disinfecting the eye and surrounding area to prevent postoperative complications was carried out on 100 patients. PVP-iodine proved superior antiseptic for pre-operative preparation of eyes before cataract surgery. It was cheaper, caused minimal side-effects, reduced bacterial counts to a great extent and eliminated fungi completely.

Helicobacter pylori infection in patients with perforated duodenal ulcer

AIM

Perforation is the commonest complication of duodenal ulcer. Helicobacter pylori is found in 95% patients with duodenal ulcer. However, there is paucity of reports on prevalence of H. pylori infection in patients with duodenal ulcer perforation. We, therefore compared the incidence of H. pylori infection in patients with duodenal ulcer perforation with the incidence in patients having complicated duodenal ulcers and non-ulcer dyspepsia.

PATIENTS AND METHODS

The study was conducted on 45 patients (complicated duodenal ulcer 15, duodenal ulcer perforation 15, non-ulcer dyspepsia 15). Per-operative punch antral biopsies were taken in patients with duodenal ulcer perforation whereas endoscopic punch biopsies of antrum were taken in patients with non-ulcer dyspepsia. The criteria for H. pylori positivity was i) growth of H. pylori on culture, ii) combination of rapid urease test (RUT) and Giemsa staining, combination of RUT and Gram stain being positive for H. pylori.

RESULTS

While 9 of 15 cases with complicated duodenal ulcer, 7 of 15 cases with non-ulcer dyspepsia were positive for H. pylori, none of the patients with duodenal ulcer perforation tested positive for H. pylori (p < 0.000). All patients with perforated duodenal ulcer had histological gastritis (H. pylori -ve). Fourteen of 15 patients (9 H. pylori +ve, 5 H. pylori -ve) with complicated duodenal ulcer and 9 of 15 patients (7 H. pylori +ve) with non-ulcer dyspepsia had histological gastritis.

CONCLUSION

Patients with duodenal ulcer perforation do not have H. pylori infection. H. pylori negative patients of duodenal ulcer may have more predilection for perforation.

Inflammatory fibroid polyp of proximal ileum causing recurrent intussusception

A 64-year-old female presented with episodes of small bowel obstruction. Ultrasound and barium meal showed a polypoidal lesion in the proximal segment of small bowel. The patient underwent emergency surgery because of signs of impending acute intestinal obstruction. Pathology showed characteristics features of an inflammatory fibroid polyp (IFP) which is an important though rare benign cause of small bowel obstruction. We document clinical and pathological aspects of this case.

Pyoderma gangrenosum in HIV patient

Pyoderma gangrenosum (PG) has previously been reported in very few patients with HIV infection. We describe here a 30-year-old housewife with HIV infection having multiple ulcerations over lower limbs characteristic of PG.

Use of transdominant mutants of the origin-binding protein (UL9) of herpes simplex virus type 1 to define functional domains

UL9, the origin-binding protein of herpes simplex virus type 1, contains six sequence motifs conserved in a large superfamily of RNA and DNA helicases. Single-amino-acid substitution mutations in these motifs inactivate UL9 function in vivo (R. Martinez, L. Shao, and S. K. Weller, J. Virol. 66:6735-6746, 1992). Overexpression of wild-type UL9 is inhibitory to plaque formation in a transfection assay which measures viral plaque formation by infectious herpes simplex virus type 1 DNA. Constructs containing mutations in motif I, II, or VI exhibit even stronger inhibitory effects in the same assay and thus can be considered strong transdominant inhibitors of plaque formation by the wild-type virus. The transdominant phenotype can be relieved by introducing a second mutation in the DNA-binding domain or by deleting the N-terminal 35 amino acids of the protein. The inhibitory effects of wild-type UL9 can also be partially relieved by deletion of amino acids 292 to 404. We propose that the N-terminal 35 amino acids of UL9 and residues 292 to 404 may define new functional domains of the UL9 protein.

Intracellular localization of the herpes simplex virus type-1 origin binding protein, UL9

UL9 is the origin binding protein of herpes simplex virus type-1 (HSV-1). A UL9-specific monoclonal antibody (17B) whose epitope maps to the N-terminal 33 amino acids was used to study the localization of UL9 in infected and transfected cells. We demonstrate the colocalization of UL9 and the HSV-1 single-strand DNA binding protein (ICP8 or UL29) in replication compartments, sites of viral DNA synthesis. On the other hand, UL9 does not completely colocalize with ICP8 in prereplicative sites, structures observed under conditions that inhibit viral DNA polymerase. Cells transfected with various deletion or pyruvate kinase fusion constructs were analyzed by indirect immunofluorescence assay to define the nuclear localization signal (NLS) of UL9. Deletion analysis showed that the region required for nuclear localization lies within the C-terminal DNA binding domian (amino acids 535-851). Various regions of UL9 were tested in fusion constructs for their ability to direct the normally cytoplasmic chicken pyruvate kinase protein to the nucleus. A fusion construct containing the carboxy-terminal 107 residues (amino acids 745-851) localized efficiently to the nucleus, whereas a fusion construct containing the N-terminal 660 amino acids of UL9 was unable to do so. Mutations designed to alter a potential NLS sequence (793-KREFAGARFKLR-804) within the C-terminal 107 residues result in a mutant UL9 protein which falls to localize efficiently to the nucleus. These results suggest that the major NLS of UL9 maps within the C-terminal 107 amino acids.

Segmental enteritis: "enteritis necroticans". A clinicopathologic study

Acute segmental enteritis, also called "enteritis necroticans" is characterized by nonocclusive intestinal ischemia in the absence of any precipitating cause. We studied 30 such patients over a 5.5-year period. All patients had acute abdominal symptoms requiring emergency laparotomy, and in only 30% was a preoperative diagnosis of segmental enteritis proposed. The jejunum alone (63.3%), or with the ileum (26.7%), was the most common site of necrotic patches (86.7%), frank gangrene (50.0%), free perforation (36.7%), and circumferential dusky lesions (30.0%). Twenty-eight patients required resection of the affected bowel. Specimen angiography in two cases showed normal mesenteric vasculature. In 12 patients, a detailed microbiological profile from peritoneal fluid, intestinal contents, and intestinal wall was performed, but Clostridium welchii was isolated from none. The resected intestinal specimens showed mucosal ulceration, submucosal edema, mixed inflammatory infiltrate, and patchy necrosis of the muscularis propria. The intramural vessels were patent in all cases. Wound-related complications occurred in 14, pulmonary complications in 14, renal failure in eight, and fecal fistulas in five; 23.3% died.

Shigellosis in children from north India: a clinicopathological study

Stool samples of 1488 children suffering from acute diarrhoea were studied for bacterial culture and sensitivity. Shigella culture was positive in 143 (10 per cent) children and 53 hospitalized children could be studied in detail. Thirty-six (68 per cent) children were under 2 years of age and peak prevalence was observed in summer months. Fever and diarrhoea were universal features; 96 per cent had blood and mucus in the stools, but 32 per cent started with watery diarrhoea lasting 1-3 days followed by dysentery. Two cases (4 per cent) had watery diarrhoea. Abdominal pain dehydration, and malnutrition were present in more than two-thirds of the cases. Central nervous systemic (CNS) manifestations, renal failure, respiratory manifestations, and subacute intestinal obstruction were seen in 45, 25, 17, and 5 per cent of cases, respectively. Shigella dysenteriae was the commonest organism grown in 57 per cent, followed by Shigella flexneri in 36 per cent, Shigella boydii in 4 per cent, and Shigella sonnei in 4 per cent cases. In the majority, the organisms were sensitive to neomycin (83 per cent), furazolidine (86 per cent), and cephaloridine (87 per cent), whereas Shigella strains were resistant to tetracycline in 93 per cent, ampicillin in 83 per cent, chloramphenicol in 91 per cent and cotrimoxazole in 66 per cent cases. Proctosigmoidoscopy was useful in defining the nature of mucosal lesion, to collect swabs for culture and biopsy specimen for histopathology. Four (8 per cent) cases had pseudomembrane and in two cases Clostridium difficile could be identified. Eight (15 per cent) cases died and two of them had shigellaemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoid tumor presenting as acute abdomen due to hemoperitoneum

A patient presenting with massive hemoperitoneum due to a large retroperitoneal carcinoid tumor is reported.

Hepatic involvement culminating in cirrhosis in a child with disseminated cryptococcosis

A 7-year-old child had unusual manifestation of cryptococcosis; liver and lymph node involvement predominated. There was evidence of cryptococcal hepatitis, extrahepatic biliary obstruction, and subsequent cirrhosis of the liver. Despite widespread dissemination, underlying immune disturbance was not evident. The patient was treated with two courses of amphotericin and 5-flucytosine.