Molecular characterization of group A rotavirus (RVA) strains detected in bovine and porcine species: Circulation of unusual rotavirus strains. A study from western, India

Group A rotaviruses (RVA) are considered as important causative agents of diarrhea in both human and animal species. Fecal specimens (n = 300) were collected from both diarrheic and healthy animals during the year 2009 from animal farms from Nagpur (Maharashtra), Western India. RVA antigen was detected by ELISA in 3.1-25% and 72% in bovine and porcine species, respectively. Genotyping based on VP6, VP7 and VP4 of RVA-positive samples showed predominance of genotype I-1 (63%) and genotype I-2 (37%), G4 (45.5%) and G10 (27.3%) genotypes, P[6] (72.7%) and P[8] (18.1%) genotypes, respectively. Other RV genotypes such as G1(4.5%), G2(9.1%), G3(4.5%) and mixed infections (9.1%) were detected at low level. Predominance of unusual G-P combinations (9/23, 39.1%) were observed. Circulation of G2P[8] and mixed infections with G1, G3, P[6] and G1, P[8], P[6]) are reported in porcine species for the first time in Western India. In conclusion the present study highlights the circulation of unusual G-P combinations and VP6 genogroup specificities of human RVA strains indicative of possible interspecies transmission and reassortment events in animal species. The study further warrants utmost need for such surveillance studies across the country to understand the role of animals as genetic reservoirs for the emergence of RVA strains pathogenic for humans. Keywords: rotaviruses; genotypes; unusual G-P types; animals.

Essential Athrombia

Four cases of essential athrombia have been diagnosed in the 14 year period from June, 1966 to June, 1980 at the Coagulation Laboratory of the Christian Medical College Hospital, Vellore. All cases fit Inceman’s description of the original case and fulfill the diagnostic criteria of prolonged bleeding time, decreased platelet aggregation, normal platelet count, normal morphology and normal clot retraction. No cases have been reported from India in the past 15 years.

Glanzmann’s Thrombasthenia

In the 14 year period from June, 1966 to June, 1980, 42 cases of Glanzmann’s thrombasthenia have been diagnosed, all fulfilling the criteria of prolonged bleeding time, with normal venous platelet count, defective clot retraction and decreased platelet aggregation, associated with a lifelong bleeding tendency. Few cases have been reported from India though it is the fourth most common congenital bleeding disorder among the patients seen at the Christian Medical College Hospital, Vellore. The large number of such cases found in South India as compared with reports from other parts of the world may be due to the high degree of consanguinity which is part of the accepted culture in this area. Reliable diagnosis of this condition is possible with fairly simple laboratory procedures.

Novel mono, di and tri-fatty acid esters bearing secondary amino acid ester head groups as transdermal permeation enhancers

Mono-oleate derivative (MOAPE) enhancing in vitro transdermal permeation of tenofovir.

Anaphylaxis in patients with hemophilia

Anaphylactic reactions are rare emergencies observed in hemophilia patients. In hemophilia (B) (HB) patients they typically occur coincident with the development of an inhibitor. It is important to be aware of the possibility of such reactions, and the patient's family should be educated at the time of initial diagnosis and discussion. Because these reactions typically occur within the first 10 to 20 treatment courses, the first few infusions should be given in a hospital/clinic setting equipped to manage such emergencies. Obtaining the exact genotype may identify the HB patients at risk for this complication. When immune tolerance induction (ITI) is attempted in patients with HB inhibitors and anaphylaxis, the physician should be vigilant in detecting proteinuria.

Hepatoblastoma with spinal metastases

Spinal cord compression secondary to metastases is an infrequent complication of childhood cancer. We describe an infant with hepatoblastoma in whom cord compression developed because of extensive epidural metastases during treatment. This is a hitherto undescribed metastatic site for hepatoblastoma.

Antibody response of infants to two doses of inactivated poliovirus vaccine of enhanced potency

The conventional formulation of injectable poliovirus vaccine (inactivated) contains 20, 2, and 4 D-antigen units of types 1, 2, and 3 polioviruses. Primary immunization requires three doses given at intervals of at least four weeks. A new formulation with 40, 8, and 32 D-antigen units of the three poliovirus types has been prepared to reduce primary immunization to two doses. We evaluated the immunogenic efficacy of this new formulation supplied to us as a liquid vaccine containing diphtheria-pertussis-tetanus vaccines and inactivated poliovirus vaccine. Two doses were administered four weeks apart to 100 infants and eight weeks apart to 114 infants. Antibody titers were determined against the three types of polioviruses before and after immunization. The effects of age, presence of maternal antibody, and interval between doses of the frequency and titers of antibody response were assessed. Irrespective of age or interval between doses, the seroconversion rates to types 1 and 3 antigens were 90% to 100%. To type 2 antigen the rate was below 84% in the 6- to 7-week-old infants, 88% to 95% in 8- to 12-week-old infants, and 90% to 100% in 13- to 45-week-old infants. The seroconversion rates and geometric mean titers of antibody were lower in those infants with maternal antibody than in those without maternal antibody at the time of receiving the first dose. The best results were in infants 8 weeks of age or older, in whom the two doses were given eight weeks apart. We recommend this schedule.

Transitional diarrhoea in newborn infants

A self-limited acute fluid diarrhoea was seen in 80 of 3550 (2.2%) live-born infants not kept in a nursery in this hospital. Rotavirus and enteropathogenic serotypes of E. coli were detected with equal frequency with and without diarrhoea. It is suggested that this self-limited episode of diarrhoea occurring soon after birth is not necessarily due to rotavirus infection but could also be due to failure of adaptation to enteral feeding and microbial colonization during this transitional period.

Latex agglutination: an appropriate technology for the diagnosis of bacterial meningitis in developing countries

We evaluated prospectively the utility of a latex agglutination technique for the diagnosis of Haemophilus influenzae type b meningitis in a paediatric ward in India. Eight of 44 children had H. influenzae grown from cerebrospinal fluid. These proven cases plus four additional cases of H. influenzae meningitis were detected by the latex agglutination test. There were no cross reactions with other organisms. The high degree of sensitivity and specificity, combined with the speed and simplicity of this technique make it an appropriate method for developing countries.

The pattern of medical renal disease in children in a south Indian hospital

A retrospective study of children admitted to a south Indian hospital during an 11 year period showed that 70% of the renal diseases encountered in children in this region are of types which have a good prognosis. Post-streptococcal glomerulonephritis was the most common. The relative prevalence of steroid-sensitive nephrotic syndrome and different histological types of idiopathic nephrotic syndrome was similar to that in developed Western countries. Haemolytic-uraemic syndrome complicating bacillary dysentery was the most common cause of acute renal failure.

Efficacy of inactivated poliovirus vaccine in India

The immunogenic efficacy of inactivated (Salk) poliovirus vaccine (IPV) was evaluated in infants in India, in view of the high frequency of vaccine failure after immunization with oral (Sabin) poliovirus vaccine (OPV). A total of 150 infants, aged 6-45 weeks, were given 3 doses of IPV, with intervals of 4 or 8 weeks between doses. The effect on the antibody response of child's age, presence of maternal antibody before immunization, and interval between doses was assessed. The overall seroconversion rates to poliovirus types 1, 2, and 3 were 99%, 89%, and 91%, respectively. Seroconversion rates to types 2 and 3, and antibody titres to types 1 and 2, were higher (i) in infants given vaccine doses at 8-week intervals and (ii) in those without detectable maternal antibody. The seroconversion rates in infants without maternal antibody, who were given IPV at 8-week intervals, were 100%, 100%, and 96.2% to poliovirus types 1, 2, and 3, respectively. Thus the immunogenic efficacy of IPV was found to be satisfactory.

Outcome of the haemolytic-uraemic syndrome complicating bacillary dysentery

Seventy-eight children were treated for the haemolytic-uraemic syndrome complicating bacillary dysentery over a ten-year period. Early dialysis favoured survival significantly. The renal status of 22 of the 28 survivors was re-evaluated 18-84 months after initial hospitalization. Complete recovery was found in all except two patients; one of them had neurological sequelae and the other a glomerulonephritic disease.

Glanzmann's thrombasthenia. A review and report of 42 cases from South India

In the 14 year period from June, 1966 to June, 1980, 42 cases of Glanzmann's thrombasthenia have been diagnosed, all fulfilling the criteria of prolonged bleeding time, with normal venous platelet count, defective clot retraction and decreased platelet aggregation, associated with a lifelong bleeding tendency. Few cases have been reported from India though it is the fourth most common congenital bleeding disorder among the patients seen at the Christian Medical College Hospital, Vellore. The large number of such cases found in South India as compared with reports from other parts of the world may be due to the high degree of consanguinity which is part of the accepted culture in this area. Reliable diagnosis of this condition is possible with fairly simple laboratory procedures.

Essential athrombia. A report on 4 cases from South India

Four cases of essential athrombia have been diagnosed in the 14 year period from June, 1966 to June, 1980 at the Coagulation Laboratory of the Christian Medical College Hospital, Vellore. All cases fit Inceman's description of the original case and fulfill the diagnostic criteria of prolonged bleeding time, decreased platelet aggregation, normal platelet count, normal morphology and normal clot retraction. No cases have been reported from India in the past 15 years.

Cystic fibrosis in South India

Cystic fibrosis has been diagnosed during life in three South Indian infants on the basis of characteristic clinical features and a positive sweat test. The patients were respectively 81 days, 23 days and 6 months old. All three presented with the rare characteristic triad of gross oedema, hypoproteinaemia and moderate to severe anaemia; it is described for the first time from South India. Three patients were exclusively breast-fed; the third received complements of diluted cow's milk. Sweat sodium and chloride were elevated in the first two cases and was normal in the third. All three died with progressive deterioration 10, 31 and 7 days respectively after admission in the hospital. At autopsy, changes typical of cystic fibrosis were present in pancreas, lung, liver and the small intestine of one, in the lungs of the second and in pancreas and liver of the third case.

Fetal growth and parental consanguinity

Anthropometric measurements made on 322 newborn infants in South India were related to parental consanguinity. Uncle-niece and first-cousin marriages were common and the average coefficient of inbreeding was as high as 0·0329. The measurements (weight, length, head circumference, and triceps and subscapular skinfold thicknesses) of the uncle-niece groups (52 infants) were smaller than those of the first-cousin group (61 infants) which in turn were smaller than the nonconsanguineous group (196 infants). Statistical significance (P<0·01) was only recorded between the weights of the three groups (means 2650·4, 2794·1, and 2833·8 g) and between the lengths of the uncle-niece group and the nonconsanguineous group (means 46·92 and 47·79 cm). There were no social class or residential differences between the groups. We conclude that there are likely to be recessive genes present in the population, slightly retarding fetal growth.

Maternal and fetal nutrition in south India

The relation between the nutrition of the mother and that of her baby was assessed in a south Indian community where malnutrition is common and women do not smoke. Unselected mothers and their infants of over 37 weeks' gestation were studied in two groups: those who paid for their care (150) and a poorer group who did not (172). There were significnat differences between the paying and non-paying groups in maternal triceps skinfold thickness, infant weight, and infant length. Overall there was a significant positive correlation between maternal triceps thickness and infant weight, length, and triceps and subscapular skinfold thickness. The correlation with the infant head circumference was less significant. These findings are further evidence that the nutrition of the mother has an important effect on the nutrition of her baby and that malnutrition is an important reason why Indian babies are lighter than European ones.

Haemolytic-uraemic syndrome complicating shigella dystentery in south Indian children

Shigella dysentery caused 65% of all cases of acute renal failure (ARF) seen in children treated at the Christian Medical College Hospital, Vellore, during the 33 months ending September 1977. In the 40 children with ARF secondary to shigella dysentery, haematological findings suggested that they were suffering from the haemolytic-uraemic syndrome, and glomerular hypercellularity and fibrin deposition were present in all 12 patients whose renal histology could be studied. Peritoneal dialysis was the main element of treatment: 43% of children who underwent dialysis improved, compared with only 25% of those who did not undergo dialysis. The haemolytic-uraemic syndrome precipitated by bacillary dystentery is therefore the most important cause of ARF in children aged under 5 years in Tamil Nadu and the adjoining area of Andhra Pradesh.