Rete middle cerebral artery presenting with a ruptured aneurysm

ABSTRACT

The developmental anomaly of the middle cerebral artery (MCA) is a rare occurrence. Rete MCA, also known as "unfused," "twig-like," and aplastic MCA, is an even rarer anomaly. These immature rete vessels are prone to flow-related aneurysms which rupture themselves presenting with intraparenchymal hematoma. We here with present a case of rete MCA with a ruptured aneurysm and discuss its pathophysiology and management.

Steroidal lactones from Withania somnifera effectively target Beta, Gamma, Delta and Omicron variants of SARS-CoV-2 and reveal a decreased susceptibility to viral infection and perpetuation: a polypharmacology approach

Prevention from disease is presently the cornerstone of the fight against COVID-19. With the rapid emergence of novel SARS-CoV-2 variants, there is an urgent need for novel or repurposed agents to strengthen and fortify the immune system. Existing vaccines induce several systemic and local side-effects that can lead to severe consequences. Moreover, elevated cytokines in COVID-19 patients with cancer as co-morbidity represent a significant bottleneck in disease prognosis and therapy. Withania somnifera (WS) and its phytoconstituent(s) have immense untapped immunomodulatory and therapeutic potential and the anticancer potential of WS is well documented. To this effect, WS methanolic extract (WSME) was characterized using HPLC. Withanolides were identified as the major phytoconstituents. In vitro cytotoxicity of WSME was determined against human breast MDA-MB-231 and normal Vero cells using MTT assay. WSME displayed potent cytotoxicity against MDA-MB-231 cells (IC50: 66 µg/mL) and no effect on Vero cells in the above range. MD simulations of Withanolide A with SARS-CoV-2 main protease and spike receptor-binding domain as well as Withanolide B with SARS-CoV spike glycoprotein and SARS-CoV-2 papain-like protease were performed using Schrödinger. Stability of complexes followed the order 6M0J-Withanolide A > 6W9C-Withnaolide B > 5WRG-Withanolide B > 6LU7-Withanolide A. Maximum stable interaction(s) were observed between Withanolides A and B with SARS-CoV-2 and SARS-CoV spike glycoproteins, respectively. Withanolides A and B also displayed potent binding to pro-inflammatory markers viz. serum ferritin and IL-6. Thus, WS phytoconstituents have the potential to be tested further in vitro and in vivo as novel antiviral agents against COVID-19 patients having cancer as a co-morbidity.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40203-023-00184-y.

Mannose-specific plant and microbial lectins as antiviral agents: A review

Lectins are non-immunological carbohydrate-binding proteins classified on the basis of their structure, origin, and sugar specificity. The binding specificity of such proteins with the surface glycan moiety determines their activity and clinical applications. Thus, lectins hold great potential as diagnostic and drug discovery agents and as novel biopharmaceutical products. In recent years, significant advancements have been made in understanding plant and microbial lectins as therapeutic agents against various viral diseases. Among them, mannose-specific lectins have being proven as promising antiviral agents against a variety of viruses, such as HIV, Influenza, Herpes, Ebola, Hepatitis, Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) and most recent Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The binding of mannose-binding lectins (MBLs) from plants and microbes to high-mannose containing N-glycans (which may be simple or complex) of glycoproteins found on the surface of viruses has been found to be highly specific and mainly responsible for their antiviral activity. MBLs target various steps in the viral life cycle, including viral attachment, entry and replication. The present review discusses the brief classification and structure of lectins along with antiviral activity of various mannose-specific lectins from plants and microbial sources and their diagnostic and therapeutic applications against viral diseases.

Nanofertilizers: Types, Delivery and Advantages in Agricultural Sustainability

In an alarming tale of agricultural excess, the relentless overuse of chemical fertilizers in modern farming methods have wreaked havoc on the once-fertile soil, mercilessly depleting its vital nutrients while inflicting irreparable harm on the delicate balance of the surrounding ecosystem. The excessive use of such fertilizers leaves residue on agricultural products, pollutes the environment, upsets agrarian ecosystems, and lowers soil quality. Furthermore, a significant proportion of the nutrient content, including nitrogen, phosphorus, and potassium, is lost from the soil (50–70%) before being utilized. Nanofertilizers, on the other hand, use nanoparticles to control the release of nutrients, making them more efficient and cost-effective than traditional fertilizers. Nanofertilizers comprise one or more plant nutrients within nanoparticles where at least 50% of the particles are smaller than 100 nanometers. Carbon nanotubes, graphene, and quantum dots are some examples of the types of nanomaterials used in the production of nanofertilizers. Nanofertilizers are a new generation of fertilizers that utilize advanced nanotechnology to provide an efficient and sustainable method of fertilizing crops. They are designed to deliver plant nutrients in a controlled manner, ensuring that the nutrients are gradually released over an extended period, thus providing a steady supply of essential elements to the plants. The controlled-release system is more efficient than traditional fertilizers, as it reduces the need for frequent application and the amount of fertilizer. These nanomaterials have a high surface area-to-volume ratio, making them ideal for holding and releasing nutrients. Naturally occurring nanoparticles are found in various sources, including volcanic ash, ocean, and biological matter such as viruses and dust. However, regarding large-scale production, relying solely on naturally occurring nanoparticles may not be sufficient or practical. In agriculture, nanotechnology has been primarily used to increase crop production while minimizing losses and activating plant defense mechanisms against pests, insects, and other environmental challenges. Furthermore, nanofertilizers can reduce runoff and nutrient leaching into the environment, improving environmental sustainability. They can also improve fertilizer use efficiency, leading to higher crop yields and reducing the overall cost of fertilizer application. Nanofertilizers are especially beneficial in areas where traditional fertilizers are inefficient or ineffective. Nanofertilizers can provide a more efficient and cost-effective way to fertilize crops while reducing the environmental impact of fertilizer application. They are the product of promising new technology that can help to meet the increasing demand for food and improve agricultural sustainability. Currently, nanofertilizers face limitations, including higher costs of production and potential environmental and safety concerns due to the use of nanomaterials, while further research is needed to fully understand their long-term effects on soil health, crop growth, and the environment.

Emerging Frontiers in Nanotechnology for Precision Agriculture: Advancements, Hurdles and Prospects

This review article provides an extensive overview of the emerging frontiers of nanotechnology in precision agriculture, highlighting recent advancements, hurdles, and prospects. The benefits of nanotechnology in this field include the development of advanced nanomaterials for enhanced seed germination and micronutrient supply, along with the alleviation of biotic and abiotic stress. Further, nanotechnology-based fertilizers and pesticides can be delivered in lower dosages, which reduces environmental impacts and human health hazards. Another significant advantage lies in introducing cutting-edge nanodiagnostic systems and nanobiosensors that monitor soil quality parameters, plant diseases, and stress, all of which are critical for precision agriculture. Additionally, this technology has demonstrated potential in reducing agro-waste, synthesizing high-value products, and using methods and devices for tagging, monitoring, and tracking agroproducts. Alongside these developments, cloud computing and smartphone-based biosensors have emerged as crucial data collection and analysis tools. Finally, this review delves into the economic, legal, social, and risk implications of nanotechnology in agriculture, which must be thoroughly examined for the technology’s widespread adoption.

Evaluation of tumor budding and its correlation with histomorphological prognostic markers in oral squamous cell carcinoma and its association with the epithelial-mesenchymal transition process

Objective

To evaluate the association of tumor budding (TB) with prognostic histomorphological parameters in oral squamous cell carcinoma (OSCC) and to investigate the correlation of TB intensity with epithelial to mesenchymal transition (EMT).

Material and Method

A total of 200 cases diagnosed as OSCC were selected and their TB status was reviewed using Hematoxylin and eosin (H and E) and Immunohistochemistry (IHC). Correlation with histomorphological prognostic parameters was done. Also, IHC for Vimentin and E-cadherin was performed to look for EMT.

Results

On H and E examination, TB was observed in 154/200 (77%). About 88/154 (57.14%) cases showed a high TB (>5 TB/10 hpf) which increased to 100/154 (64.9%) cases on IHC staining. The intensity of TB was significantly associated with tumor grade and depth of invasion. It was also significantly associated with reduced expression for E-Cadherin and upregulation of Vimentin establishing a pathogenetic correlation between the TB and EMT.

Conclusion

Therefore, our results suggest that TB is associated with poor prognosis and histologically represents EMT in OSCC which further adds to the aggressiveness of the tumor.

Modulation of interaction of BRCA1-RAD51 and BRCA1-AURKA protein complexes by natural metabolites using as possible therapeutic intervention toward cardiotoxic effects of cancer drugs: an in-silico approach

Breast cancer type 1 susceptibility protein (BRCA1) plays an important role in maintaining genome stability and is known to interact with several proteins involved in cellular pathways, gene transcription regulation and DNA damage response. More than 40% of inherited breast cancer cases are due to BRCA1 mutation. It is also a prognostic marker in non-small cell lung cancer patients as well as a gatekeeper of cardiac function. Interaction of mutant BRCA1 with other proteins is known to disrupt the tumor suppression mechanism. Two directly interacting proteins with BRCA1 namely, DNA repair protein RAD51 (RAD51) and Aurora kinase A (AURKA), known to regulate homologous recombination (HR) and G/M cell cycle transition, respectively, form protein complex with both wild and mutant BRCA1. To analyze the interactions, protein-protein complexes were generated for each pair of proteins. In order to combat the cardiotoxic effects of cancer drugs, pharmacokinetically screened natural metabolites derived from plant, marine and bacterial sources and along with FDA-approved cancer drugs as control, were subjected to molecular docking. Piperoleine B and dihydrocircumin were the best docked natural metabolites in both RAD51 and AURKA complexes, respectively. Molecular dynamics simulation (MDS) analysis and binding free energy calculations for the best docked natural metabolite and drug for both the mutant BRCA1 complexes suggested better stability for the natural metabolites piperolein B and dihydrocurcumin as compared to drug. Thus, both natural metabolites could be further analyzed for their role against the cardiotoxic effects of cancer drugs through wet lab experiments.Communicated by Ramaswamy H. Sarma.

ERCP: Energy-Efficient and Reliable-Aware Clustering Protocol for Wireless Sensor Networks

Wireless Sensor Networks (WSNs) have been around for over a decade and have been used in many important applications. Energy and reliability are two of the major problems with these kinds of applications. Reliable data delivery is an important issue in WSNs because it is a key part of how well data are sent. At the same time, energy consumption in battery-based sensors is another challenge. Therefore, efficient clustering and routing are techniques that can be used to save sensors energy and guarantee reliable message delivery. With this in mind, this paper develops an energy-efficient and reliable clustering protocol (ERCP) for WSNs. First, an efficient clustering technique is proposed for sensor nodes' energy savings considering different clustering parameters, including the link quality metric, the energy, the distance to neighbors, the distance to the sink node, and the cluster load metric. The proposed routing protocol works based on the concept of a reliable inter-cluster routing technique that saves energy. The routing decisions are made based on different parameters, such as the energy balance metric, the distance to the sink node, and the wireless link quality. Many experiments and analyses are examined to determine how well the ERCP performs. The experiment results showed that the ECRP protocol performs much better than some of the recent algorithms in both homogeneous and heterogeneous networks.

Impact of atmospheric anthropogenic nitrogen on new production in the northern Indian Ocean: constrained based on satellite aerosol optical depth and particulate nitrogen levels

Aerosols are one of the significant external sources of soluble reactive nitrogen to the surface ocean and their deposition affects the primary productivity. Owing to rapid industrialization over South and Southeast Asia, an increasing trend in atmospheric pollutants was observed over the northern Indian Ocean (NIO). To assess the contribution of the aeolian supply of inorganic nitrogen to the NIO, the available compositional data of marine aerosols collected over this basin between 2001 and 2020 were compiled. Based on the observed relationship of mass load, and particulate nitrate and ammonium concentrations with the corresponding satellite-derived anthropogenic aerosol optical depth (AAOD), the temporal, spatial, and long-term variabilities were derived for the past two decades. In particular, high aerosol mass load, nitrate and ammonium levels were observed in the coastal aerosols of peninsular India during fall and winter and they were low in summer. The atmospheric input of inorganic nitrogen to the Arabian Sea is higher (AS; 1.7 TgN per year) compared to that of the Bay of Bengal (BoB; 0.9 TgN per year) and accounts for ∼30% of the total external sources of nitrogen to the NIO. The new production, supported by external sources of nitrogen, contributes to ∼23 and 53% of export production to the oxygen minimum zone (OMZ) in the AS and BoB respectively. A significant rate of increase in the aerosol mass load (0.05-1.67 μg per m³ per year), and nitrate (0.003-0.04 μg per m³ per year) and ammonium (0.006-0.11 μg per m³ per year) concentrations was observed between 2001 and 2020, likely because of the increased emission of anthropogenic pollutants over South and Southeast Asia and their subsequent long-range atmospheric transport to the NIO. Overall, these results suggest that an enhanced contribution of atmospheric nitrogen may potentially increase (1) the N/P ratio of the surface ocean that impacts phytoplankton composition, (2) export production to the OMZ leads to intensification, and (3) sequestration of atmospheric CO₂. A decrease in primary production due to global warming is reported due to a decrease in vertical nutrient supply; however, the increase in atmospheric deposition of nutrients may compensate for this. Therefore, ocean models must be coupled with atmospheric models to better constrain the oceanic response to climate change in the NIO.

CRISPR-Based Genome Editing for Nutrient Enrichment in Crops: A Promising Approach Toward Global Food Security

The global malnutrition burden imparts long-term developmental, economic, social, and medical consequences to individuals, communities, and countries. The current developments in biotechnology have infused biofortification in several food crops to fight malnutrition. However, these methods are not sustainable and suffer from several limitations, which are being solved by the CRISPR-Cas-based system of genome editing. The pin-pointed approach of CRISPR-based genome editing has made it a top-notch method due to targeted gene editing, thus making it free from ethical issues faced by transgenic crops. The CRISPR-Cas genome-editing tool has been extensively used in crop improvement programs due to its more straightforward design, low methodology cost, high efficiency, good reproducibility, and quick cycle. The system is now being utilized in the biofortification of cereal crops such as rice, wheat, barley, and maize, including vegetable crops such as potato and tomato. The CRISPR-Cas-based crop genome editing has been utilized in imparting/producing qualitative enhancement in aroma, shelf life, sweetness, and quantitative improvement in starch, protein, gamma-aminobutyric acid (GABA), oleic acid, anthocyanin, phytic acid, gluten, and steroidal glycoalkaloid contents. Some varieties have even been modified to become disease and stress-resistant. Thus, the present review critically discusses CRISPR-Cas genome editing-based biofortification of crops for imparting nutraceutical properties.

Flavonol morin targets host ACE2, IMP-α, PARP-1 and viral proteins of SARS-CoV-2, SARS-CoV and MERS-CoV critical for infection and survival: a computational analysis

A sudden outbreak of a novel coronavirus SARS-CoV-2 in 2019 has now emerged as a pandemic threatening to efface the existence of mankind. In absence of any valid and appropriate vaccines to combat this newly evolved agent, there is need of novel resource molecules for treatment and prophylaxis. To this effect, flavonol morin which is found in fruits, vegetables and various medicinal herbs has been evaluated for its antiviral potential in the present study. PASS analysis of morin versus reference antiviral drugs baricitinib, remdesivir and hydroxychloroquine revealed that morin displayed no violations of Lipinski's rule of five and other druglikeness filters. Morin also displayed no tumorigenic, reproductive or irritant effects and exhibited good absorption and permeation through GI (clogP <5). In principal component analysis, morin appeared closest to baricitinib in 3D space. Morin displayed potent binding to spike glycoprotein, main protease 3CLPro and papain-like protease PLPro of SARS-CoV-2, SARS-CoV and MERS-CoV using molecular docking and significant binding to three viral-specific host proteins viz. human ACE2, importin-α and poly (ADP-ribose) polymerase (PARP)-1, further lending support to its antiviral efficacy. Additionally, morin displayed potent binding to pro-inflammatory cytokines IL-6, 8 and 10 also supporting its anti-inflammatory activity. MD simulation of morin with SARS-CoV-2 3CLPro and PLPro displayed strong stability at 300 K. Both complexes exhibited constant RMSDs of protein side chains and Cα atoms throughout the simulation run time. In conclusion, morin might hold considerable therapeutic potential for the treatment and management of not only COVID-19, but also SARS and MERS if studied further. Communicated by Ramaswamy H. Sarma.

Prevalence of precursor lesions (P53 signature, SCOUT, STIL, STIC) in fallopian tubes resected for non-neoplastic causes

BACKGROUND

High-grade pelvic serous carcinoma is a common cause of death in women worldwide and India. Recent evidence has clearly implicated the changes in the mucosa of the fimbrial end of the fallopian tube in its pathogenesis.

OBJECTIVE

1) To study histopathology features of surgically resected specimens of fallopian tubes received with non-neoplastic lesions of the uterus and ovary for the presence of any precursor lesions [secretory cell outgrowth (SCOUT), serous tubal intraepithelial lesion (STIL), p53 signatures, and serous tubal intraepithelial carcinoma (STIC)]. 2) To confirm the findings with immunohistochemistry. 3) To correlate the prevalence of precursor lesions with clinical parameters and benign lesions of the uterus and ovaries.

MATERIALS AND METHODS

Assessment of histopathological changes in 100 specimens of distal fallopian tubes was done using the sectioning and extensive examination of the fimbrial end (SEE-FIM) protocol. H and E stain followed by immunohistochemistry for Bcl-2, p53, and Ki-67. The statistical significance of the difference in the mean values of precursor areas was evaluated by an unpaired t-test.

RESULTS

Among 100 specimens taken on H and E, precursor lesions were suspected in 49% of the cases. SCOUT, suspicious for STIC, suspicious for STIC with areas of SCOUT, and unequivocal for STIC with areas of SCOUT were seen in 8%, 4%, 33%, and 4% of the cases, respectively. However, on IHC, SCOUTS were confirmed in 45% of the cases, p53 signature in 2%, STIL in 9%, and STIC in 4% of the cases.

CONCLUSION

Sectioning and extensive examination of the fimbrial end (SEE-FIM) should be routinely done as it provides the opportunity to detect the early malignant changes. It may help in evolving the strategies for early detection, management, and reducing mortality.

Ectopic thyroid in left parotid gland with an orthotopic thyroid gland: A rare case scenario

Benign ectopic thyroid tissue within the parotid gland is very rare with only one case reported till date in the world literature. We report a case of ectopic thyroid in the left parotid gland with an orthotopic thyroid in an elderly female, who was presented to us with the simultaneous onset of right-sided thyroid swelling and left parotid swelling for 6 months. Fine-needle aspiration cytology (FNAC) was done from both the swellings and a diagnosis of Hurthle cell neoplasm metastasizing to the left parotid gland was initially made. However, histopathological examination along with the immunohistochemistry (IHC) panel proved it to be an ectopic thyroid in the parotid. The case is being documented here for its rarity as well as an unusual presentation so that the readers are aware of this entity and the complete workup required to prevent diagnostic pitfalls.

Decadal variations in natural and anthropogenic aerosol optical depth over the Bay of Bengal: the influence of pollutants from Indo-GangeticPlain

Perennial increase in atmospheric pollution over the Bay of Bengal (BoB) and South China Sea is reported due to increase in human population and industrial activity in South and Southeast Asia. Based on total aerosol optical depth (AOD) derived from MODIS (moderate resolution imaging resolution imaging spectroradiometer), natural and anthropogenic fractions were derived. The seasonality and spatial variability in rate of increase in total, natural, and anthropogenic AOD fractions were examined over the BoB using data collected between 2001 and 2019. Both total and anthropogenic AOD displayed statistically significant rate of increase in the northwest BoB (NWB) and western coastal BoB (WCB) regions during 2001 to 2019 whereas the long-term changes are insignificant in the other regions of BoB. Significant increase in AOD in the NWB and WCB regions is mainly contributed by dominant outflow of anthropogenic emissions from Indo-Gangetic Plain (IGP) area of Indian subcontinent. The magnitude of AOD decreased by half from northern BoB to equatorial region due to increase in distance from the source region. The contribution of anthropogenic AOD was >70% to total AOD with higher contribution during winter and lower during summer. The rate of increase in both total and anthropogenic AOD was close to 0.104 and 0.099 per decade in the NWB and 0.069 and 0.059 per decade in the WCB region between 2001 and 2019. The rate of increase in total and anthropogenic AOD decreased from 2001-2009 (0.164 and 0.115 per decade respectively) to 2010-2019 (0.068 and 0.076 per decade respectively) in the NWB region. Significant increase in anthropogenic AOD by 50 and 30% was observed during El Niño and La Niña periods respectively than normal year in both northwest BoB (NWB) and western coastal (WCB) regions due to change in strength and direction of winds. Although some fraction of anthropogenic AOD is found over the entire BoB, significant rate of increase in anthropogenic AOD is found only about 23% of the area of BoB than hitherto reported as entire BoB. The impact of atmospheric deposition of anthropogenic aerosols on biogeochemical processes, such as primary production and ocean acidification, needs further evaluation.

Automated COVID-19 diagnosis and classification using convolutional neural network with fusion based feature extraction model

COVID-19 was first identified in December 2019 at Wuhan, China. At present, the outbreak of COVID-19 pandemic has resulted in severe consequences on both economic and social infrastructures of the developed and developing countries. Several studies have been conducted and ongoing still to design efficient models for diagnosis and treatment of COVID-19 patients. The traditional diagnostic models that use reverse transcription-polymerase chain reaction (rt-qPCR) is a costly and time-consuming process. So, automated COVID-19 diagnosis using Deep Learning (DL) models becomes essential. The primary intention of this study is to design an effective model for diagnosis and classification of COVID-19. This research work introduces an automated COVID-19 diagnosis process using Convolutional Neural Network (CNN) with a fusion-based feature extraction model, called FM-CNN. FM-CNN model has three major phases namely, pre-processing, feature extraction, and classification. Initially, Wiener Filtering (WF)-based preprocessing is employed to discard the noise that exists in input chest X-Ray (CXR) images. Then, the pre-processed images undergo fusion-based feature extraction model which is a combination of Gray Level Co-occurrence Matrix (GLCM), Gray Level Run Length Matrix (GLRM), and Local Binary Patterns (LBP). In order to determine the optimal subset of features, Particle Swarm Optimization (PSO) algorithm is employed. At last, CNN is deployed as a classifier to identify the existence of binary and multiple classes of CXR images. In order to validate the proficiency of the proposed FM-CNN model in terms of its diagnostic performance, extension experimentation was carried out upon CXR dataset. As per the results attained from simulation, FM-CNN model classified multiple classes with the maximum sensitivity of 97.22%, specificity of 98.29%, accuracy of 98.06%, and F-measure of 97.93%.

Recombinant Expression and Characterization of Lemon (Citrus limon) Peroxidase

BACKGROUND

Class III plant peroxidases play important role in a number of physiological processes in plants such as lignin biosynthesis, suberization, cell wall biosynthesis, reactive oxygen species metabolism and plant defense against pathogens. Peroxidases are also of significance in several industrial applications. In view of this, the production and identification of novel peroxidases having resistance towards temperature, pH, salts is desirable.

OBJECTIVE

The objective of the present work was to clone and characterize a novel plant peroxidase suitable for industrial application.

METHODS

A full length cDNA clone of lemon peroxidase was isolated using PCR and RACE approaches, characterized and heterologously expressed in Escherichia coli using standard protocols. The expressed peroxidase was purified using Ni-NTA agarose column and biochemically characterized using standard protocols. The peroxidase was also in-silico characterized at nucleotide as well as protein levels using standard protocols.

RESULTS

A full length cDNA clone of lemon peroxidase was isolated and expressed heterologously in E. coli. The expressed recombinant lemon peroxidase (LPRX) was activated by in-vitro refolding and purified. The purified LPRX exhibited pH and temperature optima of pH 7.0 and 50°C, respectively. The LPRX was found to be activated by metal ions (Na+, Ca2+, Mg2+ and Mn2+) at lower concentration. The expressional analysis of the transcripts suggested involvement of lemon peroxidase in plant defense. The lemon peroxidase was in silico modelled and docked with the substrates guaiacol, and pyrogallol and shown the favourability of pyrogallol over guaiacol, which is in agreement with the in-vitro findings. The protein function annotation analyses suggested the involvement of lemon peroxidase in the phenylpropanoid biosynthesis pathway and plant defense mechanisms.

CONCLUSION

Based on the biochemical characterization, the purified peroxidase was found to be resistant towards the salts and thus, might be a good candidate for industrial exploitation. The in-silico protein function annotation and transcript analyses highlighted the possible involvement of the lemon peroxidase in plant defense response.

Natural Products as Anti-Cancerous Therapeutic Molecules Targeted towards Topoisomerases

Topoisomerases are reported to resolve the topological problems of DNA during several cellular processes, such as DNA replication, transcription, recombination, and chromatin remodeling. Two types of topoisomerases (Topo I and II) accomplish their designated tasks by introducing single- or double-strand breaks within the duplex DNA molecules, and thus maintain the proper structural conditions of DNA to release the topological torsions, which is generated by unwinding of DNA to access coded information, in the course of replication, transcription, and other processes. Both the topoisomerases have been looked at as crucial targets against various types of cancers such as lung, melanoma, breast, and prostate cancers. Conceptually, targeting topoisomerases will disrupt both DNA replication and transcription, thereby leading to inhibition of cell division and consequently stopping the growth of actively dividing cancerous cells. Since the discovery of camptothecin (an alkaloid) as an inhibitor of Topo I in 1958, a number of derivatives of camptothecin were developed as potent inhibitors of Topo I. Two such derivatives of camptothecin, namely, topotecan and irinotecan, have been commonly used as US Food and Drug Administration (FDA) approved drugs against Topo I. Similarly, the first Topo II inhibitor, namely, etoposide, an analogue of podophyllotoxin, was developed in 1966 and got FDA approval as an anti-cancer drug in 1983. Subsequently, several other inhibitors of Topo II, such as doxorubicin, mitoxantrone, and teniposide, were developed. These drugs have been reported to cause accumulation of cytotoxic non-reversible DNA double-strand breaks (cleavable complex). Thus, the present review describes the anticancer potential of plant-derived secondary metabolites belonging to alkaloids, flavonoids and terpenoids directed against topoisomerases. Furthermore, in view of the recent advances made in the field of computer-aided drug design, the present review also discusses the use of computational approaches such as ADMET, molecular docking, molecular dynamics simulation and QSAR to assess and predict the safety, efficacy, potency and identification of these potent anti-cancerous therapeutic molecules.

Malignant Phyllodes Tumour with Rhabdomyosarcomatous Differentiation: A Rare Phenomenon

Phyllodes tumour is a rare tumour of the breast constituting less than 1% of all breast tumours. Malignant Phyllodes Tumour (MPT) accounts for only 10-30% of all phyllodes tumours. Heterologous sarcomatous differentiation in a MPT is an infrequent phenomenon, with the cases reported showing differentiation mostly towards liposarcoma, fibrosarcoma, angiosarcoma, osteosarcoma, or chondrosarcoma. MPTs with rhabdomyosarcomatous differentiation are scarcely seen with only three confirmed cases documented till date to the best of the knowledge after a thorough search of literature. Here, authors present a case of 45-year-old female who presented with a well-defined rapidly growing lump in the right breast for last one year. A core needle biopsy performed showed a sarcomatous picture on histology. Complete excision was subsequently done. On microscopy, most of the areas showed fibrosarcomatous changes with frequent mitoses. Some of the foci showed large pleomorphic cells in diffuse sheets that were polygonal with densely abundant eosinophilic cytoplasm and vesicular nucleus with prominent nucleoli (rhabdomyoblasts). Myogenin was diffusely positive on Immunohistochemistry (IHC). A diagnosis of MPT with rhabdomyosarcomatous differentiation was made. This case is reported here for its unusual presentation and to make pathologists aware of this rare heterologous differentiation of MPT.

Urine Extracellular Vesicle GATA2 mRNA Discriminates Biopsy Result in Men with Suspicion of Prostate Cancer

PURPOSE

Prostate specific antigen has limited performance in detecting prostate cancer. The transcription factor GATA2 is expressed in aggressive prostate cancer. We analyzed the predictive value of urine extracellular vesicle GATA2 mRNA alone and in combination with a multigene panel to improve detection of prostate cancer and high risk disease.

MATERIALS AND METHODS

GATA2 mRNA was analyzed in matched extracellular vesicles isolated from urines before and after prostatectomy (16) and paired urine and tissue prostatectomy samples (19). Extracellular vesicle GATA2 mRNA performance to distinguish prostate cancer and high grade disease was tested in training (52) and validation (165) cohorts. The predictive value of a multigene score including GATA2, PCA3 and TMPRSS2-ERG (GAPT-E) was tested in both cohorts.

RESULTS

Confirming its prostate origin, urine extracellular vesicle GATA2 mRNA levels decreased significantly after prostatectomy and correlated with prostate cancer tissue GATA2 mRNA levels. In the training and validation cohort GATA2 discriminated prostate cancer (AUC 0.74 and 0.66) and high grade disease (AUC 0.78 and 0.65), respectively. Notably, the GAPT-E score improved discrimination of prostate cancer (AUC 0.84 and 0.72) and high grade cancer (AUC 0.85 and 0.71) in both cohorts when compared with each biomarker alone and PT-E (PCA3 and TMPRSS2-ERG). A GAPT-E score for high grade prostate cancer would avoid 92.1% of unnecessary prostate biopsies, compared to 61.9% when a PT-E score is used.

CONCLUSIONS

Urine extracellular vesicle GATA2 mRNA analysis improves the detection of high risk prostate cancer and may reduce the number of unnecessary biopsies.

Protein Misfolding Diseases and Therapeutic Approaches

Protein folding is the process by which a polypeptide chain acquires its functional, native 3D structure. Protein misfolding, on the other hand, is a process in which protein fails to fold into its native functional conformation. This misfolding of proteins may lead to precipitation of a number of serious diseases such as Cystic Fibrosis (CF), Alzheimer's Disease (AD), Parkinson's Disease (PD), and Amyotrophic Lateral Sclerosis (ALS) etc. Protein Quality-control (PQC) systems, consisting of molecular chaperones, proteases and regulatory factors, help in protein folding and prevent its aggregation. At the same time, PQC systems also do sorting and removal of improperly folded polypeptides. Among the major types of PQC systems involved in protein homeostasis are cytosolic, Endoplasmic Reticulum (ER) and mitochondrial ones. The cytosol PQC system includes a large number of component chaperones, such as Nascent-polypeptide-associated Complex (NAC), Hsp40, Hsp70, prefoldin and T Complex Protein-1 (TCP-1) Ring Complex (TRiC). Protein misfolding diseases caused due to defective cytosolic PQC system include diseases involving keratin/collagen proteins, cardiomyopathies, phenylketonuria, PD and ALS. The components of PQC system of Endoplasmic Reticulum (ER) include Binding immunoglobulin Protein (BiP), Calnexin (CNX), Calreticulin (CRT), Glucose-regulated Protein GRP94, the thiol-disulphide oxidoreductases, Protein Disulphide Isomerase (PDI) and ERp57. ER-linked misfolding diseases include CF and Familial Neurohypophyseal Diabetes Insipidus (FNDI). The components of mitochondrial PQC system include mitochondrial chaperones such as the Hsp70, the Hsp60/Hsp10 and a set of proteases having AAA+ domains similar to the proteasome that are situated in the matrix or the inner membrane. Protein misfolding diseases caused due to defective mitochondrial PQC system include medium-chain acyl-CoA dehydrogenase (MCAD)/Short-chain Acyl-CoA Dehydrogenase (SCAD) deficiency diseases, hereditary spastic paraplegia. Among therapeutic approaches towards the treatment of various protein misfolding diseases, chaperones have been suggested as potential therapeutic molecules for target based treatment. Chaperones have been advantageous because of their efficient entry and distribution inside the cells, including specific cellular compartments, in therapeutic concentrations. Based on the chemical nature of the chaperones used for therapeutic purposes, molecular, chemical and pharmacological classes of chaperones have been discussed.

Spatial and temporal variability in concentration and characteristics of aerosols at Visakhapatnam (east) and Goa (west) coasts of India

Knowledge on the variability in quantity and compositions of various size groups of aerosols is important to understand their sources and their role in biogeochemical and climate processes. Here, we studied total suspended particles (TSP), PM₁₀ and PM_2.5 for their quantitative and water soluble compositional (F^-, Cl^-, SO₄^2-, NO₃^-, NH₄⁺, Na⁺, K⁺, Ca²⁺, and Mg²⁺) distributions, and to understand their nature and potential sources at Goa and Visakhapatnam on the west and east coasts, respectively, of India. While the mean concentrations of TSP were found to be 117 ± 44 and 85 ± 51 μg/m³ its maximal levels occurred in spring intermonsoon (SIM; 141 ± 52) and winter monsoon (WM; 155 ± 145 μg/m³) seasons at Goa and Visakhapatnam, respectively. PM₁₀ and PM_2.5 exhibited higher ranges at Visakhapatnam than Goa. The increase in PM_2.5 abundance from WM to SIM at Visakhapatnam seems to occur in coincidence with decrease in TSP favored by topography and ambient meteorological conditions. Locally released and seasonally transported (from land and sea) constituents contributed to the observed variability in aerosol compositions. Sulphate dominated the aerosol composition at both Goa (57-64%) and Visakhapatnam (43-55%) followed by NO₃^- (5-16% and 6-18%, respectively) where the former component was higher in PM₁₀ and PM_2.5. The NO₃^- was more in TSP. Relations between SO₄^2- and NH₄⁺ suggested possible presence of NH₄HSO₄. Examination of ionic ratios and balance suggested near neutrality in PM₁₀ and PM_2.5 while TSP was acidic at the both locations. Notable relations between Ca²⁺ and NO₃^-, particularly in PM₁₀ at Goa, indicated their release from mining related activities.

Cost-effective way to reduce stimulant-abuse among gay/bisexual men and transgender women: a randomized clinical trial with a cost comparison

OBJECTIVES

A randomized controlled study was conducted with 422 homeless, stimulant-using gay/bisexual (G/B) men and 29 transgender women (n = 451) to assess two community-based interventions to reduce substance abuse and improve health: (a) a nurse case-managed program combined with contingency management (NCM + CM) versus (b) standard education plus contingency management (SE + CM).

STUDY DESIGN

Hypotheses tested included: a) completion of hepatitis A/B vaccination series; b) reduction in stimulant use; and c) reduction in number of sexual partners.

METHODS

A deconstructive cost analysis approach was utilized to capture direct costs associated with the delivery of both interventions. Based on an analysis of activity logs and staff interviews, specific activities and the time required to complete each were analyzed as follows: a) NCM + CM only; b) SE + CM only; c) time to administer/record vaccines; and d) time to receive and record CM visits. Cost comparison of the interventions included only staffing costs and direct cash expenditures.

RESULTS

The study outcomes showed significant over time reductions in all measures of drug use and multiple sex partners, compared to baseline, although no significant between-group differences were detected. Cost analysis favored the simpler SE + CM intervention over the more labor-intensive NCM + CM approach. Because of the high levels of staffing required for the NCM relative to SE, costs associated with it were significantly higher.

CONCLUSIONS

Findings suggest that while both intervention strategies were equally effective in achieving desired health outcomes, the brief SE + CM appeared less expensive to deliver.

Intrapancreatic Splenule in a Pancreas Allograft: Case Report

A 16-year-old white man was involved in a motor vehicle collision and suffered head, chest, and abdominal trauma. Despite initial resuscitative efforts, he progressed to brain death and was designated to be an organ donor by his family. He had no earlier medical or surgical history and no high-risk behaviors. Blood work revealed normal creatinine, liver function tests, lipase, and amylase. Viral serologies were negative except for cytomegalovirus IgG and Epstein-Barr virus nucleic acid. Imaging revealed a right kidney contusion, a manubrial fracture, and fractures of right first rib and bilateral scapulae. No other abdominal trauma was identified, specifically to the pancreas, duodenum, or spleen. Our transplant center accepted the pancreas from this donor. During back-table inspection of the pancreas, a 1.5 × 1.5 cm dark purple rubbery mass was identified within the parenchyma of the pancreas in the tail. An incisional biopsy of the lesion was sent for frozen section, which yielded a mixed inflammatory infiltrate consisting of neutrophils and lymphocytes and an overlying fibrous capsule. The diagnosis of lymphoma or another neoplasm could not be definitely ruled out. Owing to uncertainty in diagnosis, the entire lesion was excised along with the distal pancreas with the use of a linear stapler. The staple line was oversewn with running 4-0 polypropylene suture, and the pancreas was transplanted. After surgery, the pancreas allograft functioned well with a small pancreatic leak, which had resolved by the first postoperative outpatient visit.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: Present perspectives and future horizons

AIMS

Our comprehensive review highlights the drug development and pharmacogenomics leading to the recent approval of PCSK9 inhibitors. We also review the anticipated future advances into the uses of PCSK9 inhibition.

BACKGROUND

Despite the present advances in pharmacotherapy, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality worldwide. Low density lipoprotein-cholesterol (LDL-C) lowering is the primary target for ASCVD risk reduction, showing demonstrable benefits in mortality. However, 70% of events occur even in the presence of statins. This residual risk may be approached with additional LDL-C reduction. Statin intolerance is a common clinical concern affecting adherence and the benefit with statins. There is also significant variation of individual lipid-lowering. Following rapid development, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have progressed from genetic observations, to mechanistic studies, to closer realization of the goal of CVD risk reduction. This review discusses the science behind PCSK9 inhibition, evidence of trials involving efficacy and safety, and reflections of its present and future role in clinical care, especially in high-risk patients with ASCVD, persons with suboptimal responses to statins and familial hyperlipidemia. Monoclonal antibodies have demonstrated LDL-C lowering of up to 57% as monotherapy and up to 73% when added to statins. Statins have limited efficacy in reduction of LDL-C due to an increased number of LDL-receptors. Elevated lipoprotein (a) levels may also be significantly lowered by PCSK9i. The journey from discovery to PSCK9 target validation took less than five years, and development and approval of therapeutic modalities for PCSK9 inhibitors happened over the next seven. This review highlights the drug development and pharmacogenomics leading to the recent approval of two agents, alirocumab and evolocumab, with a third bococizumab, and other novel approaches to the pathway pending.

DATA SYNTHESIS

We searched MEDLINE database via Pubmed for reviews, research publications and relevant trials available on PCSK9 inhibition.

CONCLUSION

Despite decades of medical advances, ASCVD remains one of the major causes of morbidity and mortality worldwide. Statin use has multiplied since the validation of LDL hypothesis, however, it is undeniable a more effective and well-tolerated agent is needed in significant number or patients. With the arrival of the era of unprecedented CV protection with PCSK9 inhibition, this exciting new therapy holds a pivotal promise as the future of lipid management. The data available already indicate safety, tolerability and superb efficacy of these agents, which are already changing contemporary cholesterol management. The rapid translation of innovative basic science research into drug development may lead to CV outcomes reduction and confirm that this pathway will become prominently utilized.

Typing of Plasmodium falciparum DNA from 2 years old Giemsa-stained dried blood spots using nested polymerase chain reaction assay

A panel of 129 Giemsa-stained thick blood spots (TBS) confirmed for Plasmodium falciparum infection having different levels of parasite density were collected from a malaria endemic area. DNA was extracted and nested polymerase chain reaction (PCR) assay was performed to amplify P. falciparum DNA. Nested PCR assay successfully amplified P. falciparum DNA at a very low parasitaemia of ~10 parasites/μl of blood. Current PCR assay is very simple and can be used retrospectively to monitor the invasion and prevalence of different Plasmodium species in endemic areas.

Dentin hypersensitivity following tooth preparation: A clinical study in the spectrum of gender

Objective:

The objective of this study was to estimate and compare the incidence of dentin hypersensitivity among men and women in an adult population who required replacement of missing tooth/teeth with a fixed partial prosthesis (FPD).

Materials and Methods:

The study population included 124 subjects (62 men and 62 women), who visited the out-patient department in need of FPD for replacement of missing teeth. After conducting routine examinations, each abutment tooth received two stimuli: Tactile and thermal to assess the sensitivity. The measurement of sensitivity was carried out by using a 10 cm visual analog scale before preparation and after preparation. The results were analyzed statistically using the Mann-Whitney U test.

Results:

The results showed that women reported more dentin hypersensitivity than men before and after tooth preparation.

Conclusion:

The results of the present study demonstrated that women reported more dentin hypersensitivity than men before and after tooth preparation. More studies are needed to explore this nature on gender basis.

Anti-C reactive protein antibodies in Indian patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is characterized by over production of autoantibodies. C-reactive protein (CRP) is a phylogenetically highly conserved plasma protein that participates in the systemic response to inflammation. Anti-CRP antibodies might have biological functions of pathogenetic interest in SLE. We evaluated anti-CRP antibodies in Indian SLE patients and their association with anti-dsDNA antibodies and complement levels (C3 and C4). One hundred SLE patients diagnosed according to the American College of Rheumatology criteria were included. Disease activity was assessed using SLE disease activity index (SLEDAI). Anti-CRP autoantibodies were detected by enzyme linked immunosorbent assay. Anti-dsDNA antibodies were detected by indirect immunofluroscence test (Euroimmun Lubeck, Germany). High sensitivity CRP and complement levels (C3, C4) were detected using a Nephelometer. (BN ProSpec, Dade Behring, Germany). Anti-CRP antibodies were detected in 26% of SLE patients. Mean age of disease onset among anti-CRP positives was 22.4 ± 7.5, and 26.6 ± 9.3 years among anti-CRP negatives (P > 0.05). Anti-dsDNA positivity was significantly higher among anti-CRP positives (32.7%) as compared to anti-CRP negatives (16%) (P = 0.00519). No statistically significant difference was observed in SLEDAI scores of anti-CRP positive group and anti-CRP negative group (P > 0.05). We observed a positive correlation between anti-CRP antibodies and anti-dsDNA antibodies.

Prioritizing areas for malaria control using geographical information system in Sonitpur district, Assam, India

OBJECTIVE

To identify the malaria hot spots at health subcentre level in an endemic district using a geographical information system (GIS). The results will be useful for rapid retrieval of malaria information, and to prioritize malaria control efforts in identified hot spots.

STUDY DESIGN

Extraction, analysis and synthesis of relevant data.

METHODS

Malaria epidemiological data from 2006 to 2009 were analysed to determine the annual parasitic index, slide positivity rate, annual blood examination rate and Plasmodium falciparum percentage for each health subcentre in the district. Maps were produced using GIS, and integrated to identify the malaria hotspots.

RESULTS

Out of 288 health subcentres, GIS identified 10 hot spots at extremely high risk of malaria and 14 hot spots at high risk of malaria. Malaria may flare up in these hot spots whenever favourable transmission conditions arise. Health authorities have been advised to establish control measures in these selected hot spots for timely prevention.

CONCLUSION

There is a need for adequate monitoring and allocation of available resources for better interventions in the malaria hotspots. The GIS model used in this study can be used, even at village or cluster level, to pin point the malaria hot spots, and information can be updated and retrieved easily.

Development and characterization of a cell line TTCF from endangered mahseer Tor tor (Ham.)

Tor tor is an important game and food fish of India with a distribution throughout Asia from the trans-Himalayan region to the Mekong River basin to Malaysia, Pakistan, Bangladesh and Indonesia. A new cell line named TTCF was developed from the caudal fin of T. tor for the first time. The cell line was optimally maintained at 28°C in Leibovitz-15 (L-15) medium supplemented with 20% fetal bovine serum (FBS). The propagation of TTCF cells showed a high plating efficiency of 63.00%. The cytogenetic analysis revealed a diploid count of 100 chromosomes at passage 15, 30, 45 and 60 passages. The viability of the TTCF cell line was found to be 72% after 6 months of cryopreservation in liquid nitrogen (-196°C). The origin of the cell lines was confirmed by the amplification of 578- and 655-bp sequences of 16S rRNA and cytochrome oxidase subunit I (COI) genes of mitochondrial DNA (mtDNA) respectively. TTCF cells were successfully transfected with green fluorescent protein (GFP) reporter plasmids. Further, immunocytochemistry studies confirm its fibroblastic morphology of cells. Genotoxicity assessment of H₂O₂ in TTCF cell line revealed the utility of TTCF cell line as in vitro model for aquatic toxicological studies.

Epidemiology and Risk Analysis of Malaria among Pregnant Women

Malaria remains a complex problem during the pregnancy, which threatens > 35 millions pregnant women every year. Malaria pathogenesis in pregnancy results in accumulation of infected RBCs in the intervillous spaces causing severe alterations leading to the reduced materno-foetal exchanges. In this article we have revisited the current evidences of clinical implications and overall burden of malaria in pregnancy. Many adverse aftermaths including, low birth weight, intrauterine growth retardation, preterm delivery, stillbirth and anemia were found associated with malaria in pregnant women. Despite of worldwide comprehensive control programmes for malaria in pregnancy, the disease control has been a daunting task everywhere. Socio cultural, economical, lack of awareness and various logistic problems compound the disease in developing countries. Thorough evidence based information and estimates, education and awareness and strengthening of prevention programmes are needed urgently to achieve success in malaria control in pregnancy.

Evaluation of POSSUM and P-POSSUM as a tool for prediction of surgical outcomes in the Indian population

BACKGROUND

Increased scrutiny and the need to institute a truly patient centered approach to surgical care has motivated the growing interest in measuring the quality of surgical care through comparative surgical audit. This study aimed to assess the validity of the POSSUM (Physiological and Operative Severity Score for enumeration of Mortality and Morbidity) and P-POSSUM (Portsmouth-POSSUM) score in predicting the risk of morbidity and mortality respectively in general surgical patients presenting with conditions of various operative severities at a tertiary care centre in Haryana, a northern state of India.

METHOD

A prospective study was performed in 100 general surgical patients including an equal number of patients in each of the four groups of operative severity i.e. minor, moderate, major, major plus. The risks of mortality and morbidity were calculated by using the POSSUM equation for morbidity and the P-POSSUM equation for mortality in each patient. The predicted risks were compared with the observed risks of mortality and morbidity and statistically analysed.

RESULTS

The difference in p value of predicted risk of morbidity by POSSUM equation and observed morbidity; calculated by chi square test was 0.756 which was not statistically significant. The difference in p value of predicted mortality by P-POSSUM equation and observed mortality; calculated by chi square test was 0.472 which was also not statistically significant.

CONCLUSION

POSSUM and P-POSSUM appear to be good and valid indices for use in the risk prediction of morbidity and mortality in the north Indian population.

Molecular epidemiology of measles in India, 2005-2010

Measles is a childhood disease that causes great morbidity and mortality in India and worldwide. Because measles surveillance in India is in its infancy, there is a paucity of countrywide data on circulating Measles virus genotypes. This study was conducted in 21 of 28 States and 2 of 7 Union Territories of India by MeaslesNetIndia, a national network of 27 centers and sentinel practitioners. MeaslesNetIndia investigated 52 measles outbreaks in geographically representative areas from 2005 through June 2010. All outbreaks were serologically confirmed by detection of antimeasles virus immunoglobulin M (IgM) antibodies in serum or oral fluid samples. Molecular studies, using World Health Organization (WHO)-recommended protocols obtained 203 N-gene, 40 H-gene, and 4 M-gene sequences during this period. Measles genotypes D4, D7, and D8 were found to be circulating in various parts of India during the study period. Further phylogenetic analysis revealed 4 lineages of Indian D8 genotypes: D8a, D8b, D8c, and D8d. This study generated a large, countrywide sequence database that can form the baseline for future molecular studies on measles virus transmission pathways in India. This study has created support and capabilities for countrywide measles molecular surveillance that must be carried forward.

Changing patterns of diet, physical activity and obesity among urban, rural and slum populations in north India

Rapid urbanization and accompanying lifestyle changes in India lead to transition in non-communicable disease risk factors. A survey was done in urban, urban slum and rural population of Haryana, India, in a sample of 4129 men and 3852 women using WHO STEPS questionnaire. A very high proportion of all the three populations reported inadequate intake of fruits and vegetables. Rural men reported five times physical activity as compared with urban and urban slum men and rural women reported seven times physical activity as compared with women in the other two settings. Mean body mass index (BMI) was highest among urban men (22.8 kg m(-2)) followed by urban slum (21.0 kg m(-2)) and rural men (20.6 kg m(-2)) (P-value < 0.01). Similar trend was seen for women but at a higher level than men. Prevalence of obesity (BMI >/= 30 kg m(-2)) was highest for urban population (male = 5.5%, female = 12.6%) followed by urban slum (male = 1.9%, female = 7.2%) and rural populations (male = 1.6%, female = 3.8%). Urbanization increases the prevalence of the studied non-communicable disease risk factors, with women showing a greater increase as compared with men. Non-communicable disease control strategy needs to address urbanization and warrants gender sensitive strategies specifically targeting women.

Paraesophageal hernia in the neonatal period - another differential diagnosis of esophageal atresia

Two neonates with paraesophageal herniae, both associated with gastric volvulus are reported. The presenting symptoms in both cases were highly suggestive of esophageal atresia. Radiologic examinations enabled the correct diagnosis to be made, and appropriate surgery was then instituted.