Relationship of Serum Uric Acid Level with Acute Ischemic Stroke: A Single-Center, Hospital-Based Study from Bangladesh

The role of uric acid as a risk factor for cerebrovascular disease, particularly acute ischemic stroke, is controversial and there is little information about this in our setting. This cross-sectional study was conducted at the departments of Medicine and Neurology of a tertiary hospital in Bangladesh over one year, from January 2018 to December 2018, to estimate serum uric acid (SUA) levels and assess its risk factor potential in patients with acute ischemic stroke. Forty-five patients with acute ischemic stroke were enrolled and a similar number of age and sex-matched healthy individuals were recruited for comparison. All known risk factors for stroke were searched and SUA levels were measured. SUA was higher (6.66±2.33 vs. 5.23±1.81 mg/dL; p=0.002) and hyperuricemia was more frequent (64.4% vs. 24.4%, p<0.001) in stroke patients in comparison to the controls. Hypertension was more frequent among stroke patients. In multivariate analysis, hyperuricemia [OR 4.51 (95% CI 1.67-12.16; p<0.05)] and HTN [OR 6.31 (95% CI 2.26-17.61; p<0.001)] were found to be independent risk factors of acute ischemic stroke. The stroke and control groups had no differences in age, sex, residence, education, monthly income, occupation, fasting plasma glucose, triglyceride and high-density lipoprotein cholesterol levels. Total cholesterol and low-density lipoprotein cholesterol levels were higher in the stroke patients. SUA may be used as a marker for increased risk of ischemic stroke. However, larger-scale studies are needed to get more insight into our findings.

Bone and non-contractile soft tissue changes following open kinetic chain resistance training and testosterone treatment in spinal cord injury: an exploratory study

Twenty men with spinal cord injury (SCI) were randomized into two 16-week intervention groups receiving testosterone treatment (TT) or TT combined with resistance training (TT + RT). TT + RT appears to hold the potential to reverse or slow down bone loss following SCI if provided over a longer period.

INTRODUCTION

Persons with SCI experience bone loss below the level of injury. The combined effects of resistance training and TT on bone quality following SCI remain unknown.

METHODS

Men with SCI were randomized into 16-week treatments receiving TT or TT + RT. Magnetic resonance imaging (MRI) of the right lower extremity before participation and post-intervention was used to visualize the proximal, middle, and distal femoral shaft, the quadriceps tendon, and the intermuscular fascia of the quadriceps. For the TT + RT group, MRI microarchitecture techniques were utilized to elucidate trabecular changes around the knee. Individual mixed models were used to estimate effect sizes.

RESULTS

Twenty participants completed the pilot trial. A small effect for yellow marrow in the distal femur was indicated as increases following TT and decreases following TT + RT were observed. Another small effect was observed as the TT + RT group displayed greater increases in intermuscular fascia length than the TT arm. Distal femur trabecular changes for the TT + RT group were generally small in effect (decreased trabecular thickness variability, spacing, and spacing variability; increased network area). Medium effects were generally observed in the proximal tibia (increased plate width, trabecular thickness, and network area; decreased trabecular spacing and spacing variability).

CONCLUSIONS

This pilot suggests longer TT + RT interventions may be a viable rehabilitation technique to combat bone loss following SCI.

CLINICAL TRIAL REGISTRATION

Registered with clinicaltrials.gov : NCT01652040 (07/27/2012).

Blood Coagulation and Fibrinolysis in Haemorrhagic Stroke

Studies of 11 patients with haemorrhagic stroke revealed no significant change in kaolin cephalin clotting time, prothrombin time, thrombin time, PF 3 availability, platelet count and factor V and VIII during the first week. Plasma fibrinogen was significantly increased while factors VII+X were decreased (borderline significance). Prolongation of plasma recalcification time and decrease in heparin tolerance reached borderline significance. There was moderate, but significant, increase in serum antithrombin activity and plasma (euglobulin fraction) fibrinolytic activity.

Forgotten, Encrusted Ureteral Stents: Removal - Multimodal Endourologic Approach

Ureteral stent placement is a common procedure in urologic practice. Forgotten, encrusted D/J stents represent a difficult problem for urologists. The major complications are infection, impaired renal function, migration, encrustation, stone formation and multiple fragmentation of stent. A consensus on the best therapeutic approach is still lacking. Here we present our experience with endoscopic management of this challenging problem and discuss the multimodal endourologic approaches for treating forgotten, encrusted ureteral stents. In this prospective observational study 29 patients (17 males and 12 females), age ranges from 19 to 57 years with 35 (23 unilateral and 6 bilateral) encrusted ureteral stents, indwelling for 5 to 78 months were treated in the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from January 2011 to December 2015. All patients were evaluated by urine culture and sensitivity, renal function. Stent encrustation and the associated stone burden were estimated by plain radiograph. Treatment decisions were made based on the clinical presentation, degree of encrustation, stone burden and image findings. Patients were followed up to 06 months. The main indications for stenting were pyelolithotomy, ureterolithotomy, ureteroneocystostomy, URS and pyeloplasty. In kidney, mild encrustation was common (48.3%) moderate encrustation (27.6%) was less common; where as in ureter and urinary bladder, moderate encrustation was common (72.4% and 44.8%). Over three-quarters 22(75.9%) of the patients underwent extracorporeal shockwave lithotripsy (ESWL) and 10(34.5%) percuteneousnephrostomy preoperatively. Retrograde ureteroscopy with intracorporeal lithotripsy (URS & ICPL) was done in 29 cases and cystolitholapaxy (CLL) in 16(55%) cases. Cystolithotomy & PCNL was rarely done. The mean number of procedures was 2.8 (range: 1-7). Using these multimodal approaches, all stents and associated stones were eventually removed with minor complications. Nine patients developed haematuria, 5 urosepsis and 4 both haematuria & urosepsis. Multimodal endourologic approaches can safely remove forgotten, encrusted D/J stents, if treatment is tailored to the volume of encrustation and associated stone. Imaging evaluation and documentation of negative urine culture are imperative prior to any attempt to remove the stent.

Strong Size Dependency on the Carrier and Photon Dynamics in InGaN/GaN Single Nanowalls Determined Using Photoluminescence and Ultrafast Transient Absorption Spectroscopy

Here, we have demonstrated strong size dependency of quasi-equilibrium and nonequilibrium carrier and photon dynamics in InGaN/GaN single nanowalls using photoluminescence and transient absorption spectroscopy. We demonstrate that two-dimensional carrier confinement, strain relaxation, and modified density of states lead to a reduced Stokes shift, smaller full width at half-maxima, increased exciton binding energy, and reduced nonradiative recombination. The ultrafast transient spectroscopy shows that carrier capture is a two-step process dominated by optical phonons and carrier-carrier scattering in succession. The carrier capture is a strongly size-dependent process and becomes slower due to modulation of the density of available states for progressively decreasing nanowall sizes. The slowest process is the electron-hole recombination, which is also extremely size-dependent and the rate increases by almost an order of magnitude in comparison to that of quantum-well structures. Electron-hole wave function overlap and modified density of states are among the key aspects in determining all the properties of these structures.

Efficacy and Safety of Mycobacterium indicus pranii as an adjunct therapy in Category II pulmonary tuberculosis in a randomized trial

Prolonged treatment of tuberculosis (TB) often leads to poor compliance, default and relapse, converting primary TB patients into category II TB (Cat IITB) cases, many of whom may convert to multi-drug resistant TB (MDR-TB). We have evaluated the immunotherapeutic potential of Mycobacterium indicus pranii (MIP) as an adjunct to Anti-Tubercular Treatment (ATT) in Cat II pulmonary TB (PTB) patients in a prospective, randomized, double blind, placebo controlled, multicentric clinical trial. 890 sputum smear positive Cat II PTB patients were randomized to receive either six intra-dermal injections (2 + 4) of heat-killed MIP at a dose of 5 × 10⁸ bacilli or placebo once in 2 weeks for 2 months. Sputum smear and culture examinations were performed at different time points. MIP was safe with no adverse effects. While sputum smear conversion did not show any statistically significant difference, significantly higher number of patients (67.1%) in the MIP group achieved sputum culture conversion at fourth week compared to the placebo (57%) group (p = 0.0002), suggesting a role of MIP in clearance of the bacilli. Since live bacteria are the major contributors for sustained incidence of TB, the potential of MIP in clearance of the bacilli has far reaching implications in controlling the spread of the disease.

Bone architecture adaptations after spinal cord injury: impact of long-term vibration of a constrained lower limb

SUMMARY

This study examined the effect of a controlled dose of vibration upon bone density and architecture in people with spinal cord injury (who eventually develop severe osteoporosis). Very sensitive computed tomography (CT) imaging revealed no effect of vibration after 12 months, but other doses of vibration may still be useful to test.

INTRODUCTION

The purposes of this report were to determine the effect of a controlled dose of vibratory mechanical input upon individual trabecular bone regions in people with chronic spinal cord injury (SCI) and to examine the longitudinal bone architecture changes in both the acute and chronic state of SCI.

METHODS

Participants with SCI received unilateral vibration of the constrained lower limb segment while sitting in a wheelchair (0.6g, 30 Hz, 20 min, three times weekly). The opposite limb served as a control. Bone mineral density (BMD) and trabecular micro-architecture were measured with high-resolution multi-detector CT. For comparison, one participant was studied from the acute (0.14 year) to the chronic state (2.7 years).

RESULTS

Twelve months of vibration training did not yield adaptations of BMD or trabecular micro-architecture for the distal tibia or the distal femur. BMD and trabecular network length continued to decline at several distal femur sub-regions, contrary to previous reports suggesting a "steady state" of bone in chronic SCI. In the participant followed from acute to chronic SCI, BMD and architecture decline varied systematically across different anatomical segments of the tibia and femur.

CONCLUSIONS

This study supports that vibration training, using this study's dose parameters, is not an effective anti-osteoporosis intervention for people with chronic SCI. Using a high-spatial-resolution CT methodology and segmental analysis, we illustrate novel longitudinal changes in bone that occur after spinal cord injury.

Use of local anesthesia in transrectal ultrasound guided prostatic biopsy

Transrectal ultrasound (TRUS) guided biopsy of the prostate is the gold standard for detecting prostate cancer. Intraprostatic administration of local anesthesia significantly decreases pain during prostatic biopsy. Transrectal ultrasound guided intraprostatic lidocaine administration along with intrarectally lidocaine gel is a new local anesthesia technique for prostatic biopsy. It was a randomized prospective, comparative, interventional type of the study. A total of 60 patients of age over 55 years included in the study among them 30 patients with transrectal lidocaine gel was in Group I and 30 patients with intraprostatic lidocaine injection with intra rectal gel were in Group II. The mean age was almost identically distributed between the two groups (p=0.668). About 47% of patients in Group I exhibited hard prostate on digital rectal examination (DRE), 33.3% single nodule and 20% multinodule compared to 33.3% of patients in Group II had hard prostate, 26.7% single nodule and 40% multinodule (p=0.236). The mean serum prostate specific antigen (PSA) was significantly higher in Group II than that in Group I (36.7±9.2 vs. 7.5±5.8ng/ml; p=0.007). The mean pain intensity during biopsy was almost two times higher in Group I than in Group II (p<0.001). The present study concludes that the intraprostatic lidocaine injection along with intra rectal lidocaine gel is less painful method and can be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.

High dose compressive loads attenuate bone mineral loss in humans with spinal cord injury

People with spinal cord injury (SCI) lose bone and muscle integrity after their injury. Early doses of stress, applied through electrically induced muscle contractions, preserved bone density at high-risk sites. Appropriately prescribed stress early after the injury may be an important consideration to prevent bone loss after SCI.

INTRODUCTION

Skeletal muscle force can deliver high compressive loads to bones of people with spinal cord injury (SCI). The effective osteogenic dose of load for the distal femur, a chief site of fracture, is unknown. The purpose of this study is to compare three doses of bone compressive loads at the distal femur in individuals with complete SCI who receive a novel stand training intervention.

METHODS

Seven participants performed unilateral quadriceps stimulation in supported stance [150% body weight (BW) compressive load-"High Dose" while opposite leg received 40% BW-"Low Dose"]. Five participants stood passively without applying quadriceps electrical stimulation to either leg (40% BW load-"Low Dose"). Fifteen participants performed no standing (0% BW load-"Untrained") and 14 individuals without SCI provided normative data. Participants underwent bone mineral density (BMD) assessment between one and six times over a 3-year training protocol.

RESULTS

BMD for the High Dose group significantly exceeded BMD for both the Low Dose and the Untrained groups (p < 0.05). No significant difference existed between the Low Dose and Untrained groups (p > 0.05), indicating that BMD for participants performing passive stance did not differ from individuals who performed no standing. High-resolution CT imaging of one High Dose participant revealed 86% higher BMD and 67% higher trabecular width in the High Dose limb.

CONCLUSION

Over 3 years of training, 150% BW compressive load in upright stance significantly attenuated BMD decline when compared to passive standing or to no standing. High-resolution CT indicated that trabecular architecture was preserved by the 150% BW dose of load.

Carbohydrate response element-binding protein (ChREBP) plays a pivotal role in beta cell glucotoxicity

AIMS/HYPOTHESIS

This study was aimed at the elucidation of the pathogenesis of glucotoxicity, i.e. the mechanism whereby hyperglycaemia damages pancreatic beta cells. The identification of pathways in the process may help identify targets for beta cell-protective therapy. Carbohydrate response element-binding protein (ChREBP), a transcription factor that regulates the expression of multiple hyperglycaemia-induced genes, is produced in abundance in pancreatic beta cells. We hypothesise that ChREBP plays a pivotal role in mediating beta cell glucotoxicity.

METHODS

We assessed the role of ChREBP in glucotoxicity in 832/13 beta cells, isolated mouse islets and human pancreas tissue sections using multiple complementary approaches under control and high-glucose-challenge conditions as well as in adeno-associated virus-induced beta cell-specific overexpression of Chrebp (also known as Mlxipl) in mice.

RESULTS

Under both in vitro and in vivo conditions, ChREBP activates downstream target genes, including fatty acid synthase and thioredoxin-interacting protein, leading to lipid accumulation, increased oxidative stress, reduced insulin gene transcription/secretion and enhanced caspase activity and apoptosis, processes that collectively define glucotoxicity. Immunoreactive ChREBP is enriched in the nucleuses of beta cells in pancreatic tissue sections from diabetic individuals compared with non-diabetic individuals. Finally, we demonstrate that induced beta cell-specific Chrebp overexpression is sufficient to phenocopy the glucotoxicity manifestations of hyperglycaemia in mice in vivo.

CONCLUSIONS/INTERPRETATION

These data indicate that ChREBP is a key transcription factor that mediates many of the hyperglycaemia-induced activations in a gene expression programme that underlies beta cell glucotoxicity at the molecular, cellular and whole animal levels.

A new osteophyte segmentation algorithm using partial shape model and its applications to rabbit femur anterior cruciate ligament transection via micro-CT imaging

Osteophyte is an additional bony growth on a normal bone surface limiting or stopping motion at a deteriorating joint. Detection and quantification of osteophytes from CT images is helpful in assessing disease status as well as treatment and surgery planning. However, it is difficult to distinguish between osteophytes and healthy bones using simple thresholding or edge/texture features due to the similarity of their material composition. In this paper, we present a new method primarily based active shape model (ASM) to solve this problem and evaluate its application to anterior cruciate ligament transection (ACLT) rabbit femur model via CT imaging. The common idea behind most ASM based segmentation methods is to first build a parametric shape model from a training dataset and apply the model to find a shape instance in a target image. A common challenge with such approaches is that a diseased bone shape is significantly altered at regions with osteophyte deposition misguiding an ASM method and eventually leading to suboptimum segmentations. This difficulty is overcome using a new partial ASM method that uses bone shape over healthy regions and extrapolates it over the diseased region according to the underlying shape model. Finally, osteophytes are segmented by subtracting partial-ASM derived shape from the overall diseased shape. Also, a new semi-automatic method is presented in this paper for efficiently building a 3D shape model for an anatomic region using manual reference of a few anatomically defined fiducial landmarks that are highly reproducible on individuals. Accuracy of the method has been examined on simulated phantoms while reproducibility and sensitivity have been evaluated on CT images of 2-, 4- and 8-week post-ACLT and sham-treated rabbit femurs. Experimental results have shown that the method is highly accurate ( R2 = 0.99), reproducible (ICC = 0.97), and sensitive in detecting disease progression (p-values: 0.065,0.001 and < 0.001 for 2- vs. 4, 4- vs. 8- and 2- vs. 8-weeks, respectively).

Puberty menorrhagia Requiring Inpatient Admission

INTRODUCTION: Puberty menorrhagia is a significant health problem in adolescent age group and severe cases may require admission and blood transfusion. Aim of this study was to evaluate the causes, associated complications and management of puberty menorrhagia. METHODS: Hospital records of all patients of puberty menorrhagia requiring admission were analyzed for etiology, duration since menarche, duration of bleeding, investigation profile and management. RESULTS: There were 18 patients of puberty menorrhagia requiring hospital admission. Etiology was anovulatory bleeding in 11 patients, bleeding disorders in five which included idiopathic thrombocytopenia purpura in three and one each with Von-Willebrand disease and leukemia. Two patients had hypothyroidism as the cause. Fourteen patients presented with severe anaemia and required blood transfusion. All except one responded to oral hormonal therapy. CONCLUSIONS: Puberty menorrhagia can be associated with severe complications and requiring blood transfusion. Although most common cause is anovulation but bleeding disorder, other medical condition and other organic causes must be ruled out in any patient of Puberty menorrhagia.KEYWORDS: anovulation, bleeding disorder, puberty, menorrhagia, anaemia.

Puberty menorrhagia requiring inpatient admission

INTRODUCTION

Puberty menorrhagia is a significant health problem in adolescent age group and severe cases may require admission and blood transfusion. Aim of this study was to evaluate the causes, associated complications and management of puberty menorrhagia.

METHODS

Hospital records of all patients of puberty menorrhagia requiring admission were analyzed for etiology, duration since menarche, duration of bleeding, investigation profile and management.

RESULTS

There were 18 patients of puberty menorrhagia requiring hospital admission. Etiology was anovulatory bleeding in 11 patients, bleeding disorders in five which included idiopathic thrombocytopenia purpura in three and one each with Von-Willebrand disease and leukemia. Two patients had hypothyroidism as the cause. Fourteen patients presented with severe anaemia and required blood transfusion. All except one responded to oral hormonal therapy.

CONCLUSIONS

Puberty menorrhagia can be associated with severe complications and requiring blood transfusion. Although most common cause is anovulation but bleeding disorder, other medical condition and other organic causes must be ruled out in any patient of Puberty menorrhagia.

The trivialization of diagnosis

Although it is widely recognized that diagnosis plays a central role in clinical medicine, in recent years the primacy of diagnosis has come under attack from several sources. 1. "Billable terms" are replacing traditional medical diagnoses. The former are based on International Classification of Diseases lists, which include many non-diagnoses such as symptoms and signs. 2. Diagnosis often gets short shrift because of the perceived urgency of discharge. 3. The problem oriented record, in practice, has frequently led to a shift in emphasis from synthesis of findings to fragmentation of problems. 4. Presumptive diagnoses frequently metamorphose into established diagnoses in medical records, even if incorrect. 5. A number of authors have apparently disparaged the importance of diagnosis. Nonetheless, it is clear that diagnosis must continue to play a central role in clinical medicine. We propose several ways by which we can resist these forces and assure that diagnosis retains its appropriate position of primacy.

Three-body nonmesonic weak decay of the (Lambda)12C hypernucleus

We have measured the branching ratio of the three-body process in the nonmesonic weak decay of Lambda12C to be 0.29+/-0.13. This result was obtained by reproducing the nucleon and the nucleon pair yields introducing a measured final state interaction. At the same time, we have determined the absolute decay widths, Gamma(n) and Gamma(p), along with Gamma2N, whose relative ratio has been a long-standing puzzle. Including the three-body process, we have successfully reproduced the nucleon energy distribution, the coincidence two-nucleon angular correlation, and the momentum sum distribution simultaneously.

Kinetics of growth and multi substrate degradation by an indigenous mixed microbial culture isolated from a wastewater treatment plant in Guwahati, India

An indigenous mixed culture of microorganisms, isolated from a sewage treatment plant, was investigated for its potential to simultaneously degrade phenol and m-cresol during its growth in batch shake flasks. 2(2) full factorial designs with the two substrates as the factors, at two different levels and two different initial concentration ranges, were employed to carry out the biodegradation experiments. For complete utilisation of phenol and m-cresol, the culture took a minimum duration of 21 hrs at their low concentration of 100 mg/L each, and a maximum duration of 187 hrs at high concentration of 600 mg/L each in the multisubstrate system. The biodegradation results also showed that the presence of phenol in low concentration range (100-300 mg/L did not inhibit m-cresol biodegradation; on the other hand, presence of m-cresol inhibited phenol biodegradation by the culture. Moreover, irrespective of the concentrations used, phenol was degraded preferentially and earlier than m-cresol. During the culture growth, a lag phase was observed above a combined concentration of 500 mg/L i.e., 200 mg/L m-cresol and 300 mg/L of phenol and above). Statistical analysis of the specific growth rate of the culture in the multisubstrate system was also performed in the form of ANOVA and Student 't' test, which gave good interpretation in terms of main and interaction effects of the substrates.

Structural MRI of carotid artery atherosclerotic lesion burden and characterization of hemispheric cerebral blood flow before and after carotid endarterectomy

Collateral circulation plays a major role in maintaining cerebral blood flow (CBF) in patients with internal carotid artery (ICA) stenosis. CBF can remain normal despite severe ICA stenosis, making the benefit of carotid endarterectomy (CEA) or stenting difficult to assess. Before and after surgery, we assessed CBF supplied through the ipsilateral (stenotic) or contralateral ICA individually with a novel hemisphere-selective arterial spin-labeling (ASL) perfusion MR technique. We further explored the relationship between CBF and ICA obstruction ratio (OR) acquired with a multislice black-blood imaging sequence. For patients with unilateral ICA stenosis (n = 19), conventional bilateral labeling did not reveal interhemispheric differences. With unilateral labeling, CBF in the middle cerebral artery (MCA) territory on the surgical side from the ipsilateral supply (53.7 +/- 3.3 ml/100 g/min) was lower than CBF in the contralateral MCA territory from the contralateral supply (58.5 +/- 2.7 ml/100 g/min), although not statistically significant (p = 0.09). The ipsilateral MCA territory received significant (p = 0.02) contralateral supply (7.0 +/- 2.7 ml/100 g/min), while ipsilateral supply to the contralateral side was not reciprocated. After surgery (n = 11), ipsilateral supply to the MCA territory increased from 57.3 +/- 5.7 to 67.3 +/- 5.4 ml/100 g/min (p = 0.03), and contralateral supply to the ipsilateral MCA territory decreased. The best predictor of increased CBF on the side of surgery was normalized presurgical ipsilateral supply (r(2) = 0.62, p = 0.004). OR was less predictive of change, although the change in normalized contralateral supply was negatively correlated with OR(excess) (=OR(ipsilateral) - OR(contralateral)) (r(2) = 0.58, p = 0.006). The results demonstrate the effect of carotid artery stenosis on blood supply to the cerebral hemispheres, as well as the relative role of collateral pathways before surgery and redistribution of blood flow through these pathways after surgery. Unilateral ASL may better predict hemodynamic surgical outcome (measured by improved perfusion) than ICA OR.

Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis

OBJECTIVE

To study the predictors of development and determinants of outcome in patients with acute respiratory distress syndrome (ARDS) due to tuberculosis (TB).

METHODS

Retrospective case-control study of demographic, clinical and laboratory data of hospitalised adult patients with active TB.

RESULTS

Of 2733 TB patients treated during 1980-2003, 29 (1.06%; 1.21 patients/year; mean age 31.6 +/- 10.9 years; 16 males) developed ARDS (cases). Seven had pulmonary TB and 22 had miliary TB (MTB); 298 (mean age 32.0 +/- 14.2 years; 110 males) who did not develop ARDS constituted controls. Presence of MTB (OR 4.6, 95%CI 1.2-17.8; P = 0.02), duration of illness beyond 30 days at presentation (OR 177.9, 95%CI 39-811.7; P < 0.001), absolute lymphocyte count < 1625/ mm3 (OR 4.5, 95%CI 1.1-19.3; P = 0.04) and serum ALT > 100 IU (OR 15.7, 95%CI 3.0-81.1, P < 0.001) were independent predictors of ARDS development. Twelve cases died (41.4%). Patients with APACHE II score >18; those with APACHE II score <18 in the presence of hyponatraemia and PaO2/FIO2 ratio <108.5 were likely to die.

CONCLUSIONS

In patients with TB, prolonged illness, MTB, absolute lymphocytopaenia and elevated ALT are independently associated with ARDS development. APACHE II score, serum sodium and PaO2/FIO2 ratio are determinants of outcome.

Exclusive measurement of the nonmesonic weak decay of the lambda(5)He hypernucleus

We performed a coincidence measurement of two nucleons emitted from the nonmesonic weak decay of lambda(5)He formed via the 6Li(pi+, K+) reaction. The energies of the two nucleons and the pair number distributions in the opening angle between them were measured. In both np and nn pairs, we observed a clean back-to-back correlation coming from the two-body weak reactions of lambda p --> np and lambda n --> nn, respectively. The ratio of the nucleon pair numbers was N(nn)/N(np) = 0.45 +/- 0.11(stat) +/- 0.03(syst) in the kinematic region of cos theta(NN) < -0.8. Since each decay mode was exclusively detected, the measured ratio should be close to the ratio of gamma(lambda p --> np)/gamma(lambda n --> nn). The ratio is consistent with recent theoretical calculations based on the heavy meson and/or direct-quark exchange picture.

Leech bite: a rare gynecologic emergency

Vaginal bleeding as the result of a leech bite is a rare occurrence. We report 2 cases of vaginal bleeding in young girls that resulted from a leech bite and required treatment. Clinical presentation and management for young girls is described. Health professionals working in rural areas where leech infestation is common should be aware that children are at risk for leech bites in the genital region; a high index of suspicion is of great help to make an early diagnosis and ensure prompt treatment.

Reversal of subclinical adrenal insufficiency through antituberculosis treatment in TB patients: a longitudinal follow up

BACKGROUND & OBJECTIVE

Subclinical adrenal insufficiency has been shown to occur in patients with tuberculosis. Whether this insufficiency can be reversed with therapy and on long-term follow up, is not known. We studied the effect of antituberculosis treatment (ATT) with respect to reversal of the adrenal insufficiency, as assessed by response to standard dose adrenocorticotropin (ACTH) stimulation test in TB patients.

METHODS

One hundred and five HIV-negative tuberculosis patients were studied. Of these, 72 patients had pulmonary and 33 had extrapulmonary forms of the disease. Baseline (pre-treatment) standard-dose ACTH stimulation test was done on all the subjects, following which, they were put on standard antituberculosis therapy, depending on the type of disease and were followed up for a period of 30 months. ACTH stimulation tests were performed at follow up, every 6 months.

RESULTS

Baseline (pre-treatment) standard-dose ACTH stimulation test revealed an impaired response in 52 of 105 patients (49.5%). At 6 months, the percentage of responders had increased to 71 per cent with a gradual increasing trend noted thereafter. At 24 months, 31 of the 32 patients (97%) who were followed up demonstrated a normal response to ACTH stimulation. The percentage of responders was comparable in both pulmonary [21 of 22 patients (95%)] and extrapulmonary TB [10 of 10 patients (100%)] groups at follow up.

INTERPRETATION & CONCLUSION

Our study shows that nearly half of patients with active tuberculosis had a subclinical adrenal insufficiency indicated by an impaired response to ACTH stimulation test. This insufficiency reverse with therapy in most patients on long-term follow up.

Contraceptive practices and awareness of emergency contraception in educated working women

BACKGROUND

Regular contraceptive use and emergency contraception are tools to prevent pregnancies.

AIMS

This study was designed to investigate knowledge and use of contraceptive methods and awareness of emergency contraception among women working in the hospital.

SETTINGS

Educated workingwomen in a medical college hospital.

DESIGN

Cross-sectional study.

MATERIALS AND METHODS

The study was carried out among women belonging to three categories: staff nurses, ministerial staff and others. Married as well as unmarried employees in the reproductive age group were interviewed. A pretested mixed questionnaire containing open as well as closed ended questions was administered. The women were asked questions concerning knowledge and use of contraceptive methods and awareness of emergency or postcoital contraception.

RESULTS

Of the 284 employees 258 women consented for the interview. All the subjects were literate and majority (97.2%) had an urban background. Of the 190 married women, 154 (81.1%) practiced contraception, among them (73.3%) were regular users. Eighty respondents underwent abortions of which 46 had spontaneous and 34 had induced abortions. Among the available contraceptive methods, condom was the most popular method in 89 (57.8%) followed by Copper T in 38 women (24.7%). The use of hormonal contraception was very low 2.6%. Print and electronic media were the common source of public awareness in 149 subjects (57.7%). Twenty-nine women (11.2%) were aware and only three women used emergency contraception.

CONCLUSIONS

A high percentage of females in this literate workingwomen population used contraception; however, the awareness of emergency contraception was low.

Contraceptive practices and awareness of emergency contraception in educated working women

BACKGROUND

Regular contraceptive use and emergency contraception are tools to prevent pregnancies.

AIMS

This study was designed to investigate knowledge and use of contraceptive methods and awareness of emergency contraception among women working in the hospital.

SETTINGS

Educated workingwomen in a medical college hospital.

DESIGN

Cross-sectional study.

MATERIALS AND METHODS

The study was carried out among women belonging to three categories: staff nurses, ministerial staff and others. Married as well as unmarried employees in the reproductive age group were interviewed. A pretested mixed questionnaire containing open as well as closed ended questions was administered. The women were asked questions concerning knowledge and use of contraceptive methods and awareness of emergency or postcoital contraception.

RESULTS

Of the 284 employees 258 women consented for the interview. All the subjects were literate and majority (97.2%) had an urban background. Of the 190 married women, 154 (81.1%) practiced contraception, among them (73.3%) were regular users. Eighty respondents underwent abortions of which 46 had spontaneous and 34 had induced abortions. Among the available contraceptive methods, condom was the most popular method in 89 (57.8%) followed by Copper T in 38 women (24.7%). The use of hormonal contraception was very low 2.6%. Print and electronic media were the common source of public awareness in 149 subjects (57.7%). Twenty-nine women (11.2%) were aware and only three women used emergency contraception.

CONCLUSIONS

A high percentage of females in this literate workingwomen population used contraception; however, the awareness of emergency contraception was low.

Mechanics of the ankle and subtalar joints revealed through a 3D quasi-static stress MRI technique

A technique to study the three-dimensional (3D) mechanical characteristics of the ankle and of the subtalar joints in vivo and in vitro is described. The technique uses an MR scanner compatible 3D positioning and loading linkage to load the hindfoot with precise loads while the foot is being scanned. 3D image processing algorithms are used to derive from the acquired MR images bone morphology, hindfoot architecture, and joint kinematics. The technique was employed to study these properties both in vitro and in vivo. The ankle and subtler joint motion and the changes in architecture produced in response to an inversion load and an anterior drawer load were evaluated. The technique was shown to provide reliable measures of bone morphology. The left-to-right variations in bone morphology were less than 5%. The left-to-right variations in unloaded hindfoot architecture parameters were less than 10%, and these properties were only slightly affected by inversion and anterior drawer loads. Inversion and anterior drawer loads produced motion both at the ankle and at the subtalar joint. In addition, high degree of coupling, primarily of internal rotation with inversion, was observed both at the ankle and at the subtalar joint. The in vitro motion produced in response to inversion and anterior drawer load was greater than the in vivo motion. Finally, external motion, measured directly across the ankle complex, produced in response to load was much greater than the bone movements measured through the 3D stress MRI technique indicating the significant effect of soft tissue and skin interference.

Production of the neutron-rich hypernucleus 10LambdaLi in the (pi-,K+) double charge-exchange reaction

In order to produce a neutron-rich Lambda hypernucleus for the first time, we carried out an experiment by utilizing the (pi-,K+) double charge-exchange reaction on a 10B target. We observed the production of a 10LambdaLi hypernucleus. The cross section for the Lambda bound region was found to be 11.3+/-1.9 nb/sr with the 1.2 GeV/c incident momentum, which is compared with the 10LambdaB hypernucleus production cross section, 7.8+/-0.3 microb/sr, in the (pi+,K+) reaction with a 1.05 GeV/c incident momentum beam.

Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India

BACKGROUND

Literature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV)-infected patients from developing countries is sparse. The objective of this study was to document the spectrum and determine the frequency of various opportunistic infections (OIs) and non-infectious opportunistic diseases, in hospitalised HIV-infected patients from north India.

METHODS

One hundred and thirty five consecutive, HIV-infected patients (age 34 +/- 10 years, females 17%) admitted to a tertiary care hospital in north India, for the evaluation and management of an OI or HIV-related disorder between January 2000 and July 2003, were studied.

RESULTS

Fever (71%) and weight loss (65%) were the commonest presenting symptoms. Heterosexual transmission was the commonest mode of HIV-acquisition. Tuberculosis (TB) was the commonest OI (71%) followed by candidiasis (39.3%), Pneumocystis jiroveci pneumonia (PCP) (7.4%), cryptococcal meningitis and cerebral toxoplasmosis (3.7% each). Most of the cases of TB were disseminated (64%). Apart from other well-recognised OIs, two patients had visceral leishmaniasis. Two cases of HIV-associated lymphoma were encountered. CD4+ cell counts were done in 109 patients. Majority of the patients (82.6%) had CD4+ counts <200 cells/microL. Fifty patients (46%) had CD4+ counts <50 cells/microL. Only 50 patients (37%) received antiretroviral therapy. Twenty one patients (16%) died during hospital stay. All but one deaths were due to TB (16 patients; 76%) and PCP (4 patients; 19%).

CONCLUSIONS

A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India. Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

Reproducibility and error sources of micro-MRI-based trabecular bone structural parameters of the distal radius and tibia

The mechanical competence of trabecular bone is significantly determined, next to material density, by its three-dimensional (3D) structure. Recent advances in micromagnetic resonance imaging (micro-MRI) acquisition and processing techniques allow the 3D trabecular structure to be analyzed in vivo at peripheral sites such as the distal radius and tibia. The practicality of micro-MRI-based noninvasive virtual bone biopsy (VBB) for longitudinal studies of patients hinges on the reproducibility of the derived structural parameters, which largely determine the size of the effect that can be detected at a given power and significance level. In this paper, the reproducibility of micro-MRI-derived trabecular bone structure measures was examined by performing repeat studies in six healthy subjects in whom the distal aspects of the radius and tibia were scanned with a 3D spin-echo sequence at 137 x 137 x 410 microm3 voxel size. Bone volume fraction (BV/TV) and digital topological analysis (DTA) structural parameters including the topological bone surface-to-curve ratio (SCR) and topological erosion index (TEI) were evaluated after subjecting the raw images to a cascade of processing steps. The average coefficient of variation was 4-7% and was comparable for the two anatomic sites and for all parameters measured. The reliability expressed in terms of the intraclass correlation coefficient ranged from 0.95 to 0.97 in the radius and 0.68 to 0.92 in the tibia. Error analysis based on simulations suggests involuntary patient motion, primarily rotation, to be the chief source of imprecision, followed by failure to accurately match the analysis volumes in repeat studies.

Clinical and genetic risk factors for the development of multi-drug resistant tuberculosis in non-HIV infected patients at a tertiary care center in India: a case-control study

Genetic susceptibility of the host to multi-drug resistant tuberculosis (MDR-TB) is not fully understood. We undertook a case-control study at a tertiary care center at New Delhi, India to identify the clinical and genetic predictors of MDR-TB as compared to the drug sensitive TB cases. Patients with multi-drug resistant tuberculosis were identified on the basis of drug sensitivity testing by the proportion method. Treatment was initiated according to standard norms and all patients were followed up during the period. Genomic DNA extracted from the peripheral blood mononuclear cell pellet was used for amplification of HLA class II region (second exon) with a set of forward (5') and reverse (3') primers. A sequence specific 5' biotinylated probes were used to determine 12 DRB1, 8 DQA1 and 13 DQB1 alleles by the PCR-SSOP method. Past history of disease, higher severity of illness, inadequacy of drug treatment and presence of HLA-DRB1*14, DQB1*0503 and DQB1*0502 alleles were found to be significant risk factors for MDR-TB. Multivariate analysis identified poor past compliance to treatment (odds ratio, OR=6.6; 95% confidence interval, CI [2.0-21.5]), higher number of cavities (OR=6; 95% CI [2.1-17.3]) in chest radiographs and the presence of the HLA-DRB1*14 allele (OR=8.2; 95% CI [2.1-31.3]) as independent predictors of MDR-TB. Our results suggest that a combination of clinical and immunogenetic parameters could provide better information on drug resistance in tuberculosis with implications in therapy.

Increasing HIV seropositivity among adult tuberculosis patients in Delhi

We report the HIV seropositivity among adult TB patients from our hospital, a tertiary care hospital in north India between 2000-2002. Of the 555 patients with various forms of tuberculosis, 52 were found to be seropositive (9.4%). In 1994-1999, the HIV seropositivity in this hospital was only 0.4 per cent (2 of 500 patients). This communication describes a dramatic increase in seropositivity and highlights the importance of continued HIV serosurveillance in patients with TB.

Sigma-nucleus potential in A=28

We have studied the (pi(-),K+) reaction on a silicon target to investigate the sigma-nucleus potential. The inclusive spectrum was measured at a beam momentum of 1.2 GeV/c with an energy resolution of 3.3 MeV (FWHM) by employing the superconducting kaon spectrometer system. The spectrum was compared with theoretical calculations within the framework of the distorted-wave impulse approximation, which demonstrates that a strongly repulsive sigma-nucleus potential with a nonzero size of the imaginary part reproduces the observed spectrum.

Observation of a (6)(LambdaLambda)He double hypernucleus

A double-hyperfragment event has been found in a hybrid-emulsion experiment. It is identified uniquely as the sequential decay of ( 6)(LambdaLambda)He emitted from a Xi(-) hyperon nuclear capture at rest. The mass of ( 6)(LambdaLambda)He and the Lambda-Lambda interaction energy DeltaB(LambdaLambda) have been measured for the first time devoid of the ambiguities due to the possibilities of excited states. The value of DeltaB(LambdaLambda) is 1.01+/-0.20(+0.18)(-0.11) MeV. This demonstrates that the Lambda-Lambda interaction is weakly attractive.

Scale-based diffusive image filtering preserving boundary sharpness and fine structures

Image acquisition techniques often suffer from low signal-to-noise ratio (SNR) and/or contrast-to-noise ratio (CNR). Although many acquisition techniques are available to minimize these, post acquisition filtering is a major off-line image processing technique commonly used to improve the SNR and CNR. A major drawback of filtering is that it often diffuses/blurs important structures along with noise. In this paper, we introduce two scale-based filtering methods that use local structure size or "object scale" information to arrest smoothing around fine structures and across even low-gradient boundaries. The first of these methods uses a weighted average over a scale-dependent neighborhood while the other employs scale-dependent diffusion conductance to perform filtering. Both methods adaptively modify the degree of filtering at any image location depending on local object scale. Object scale allows us to accurately use a restricted homogeneity parameter for filtering in regions with fine details and in the vicinity of boundaries while a generous parameter in the interiors of homogeneous regions. Qualitative experiments based on both phantoms and patient magnetic resonance images show significant improvements using the scale-based methods over the extant anisotropic diffusive filtering method in preserving fine details and sharpness of object boundaries. Quantitative analyses utilizing 25 phantom images generated under a range of conditions of blurring, noise, and background variation confirm the superiority of the new scale-based approaches.

Digital topological analysis of in vivo magnetic resonance microimages of trabecular bone reveals structural implications of osteoporosis

Osteoporosis is a disease characterized by bone volume loss and architectural deterioration. The majority of work aimed at evaluating the structural implications of the disease has been performed based on stereologic analysis of histomorphometric sections. Only recently noninvasive imaging methods have emerged that provide sufficient resolution to resolve individual trabeculae. In this article, we apply digital topological analysis (DTA) to magnetic resonance microimages (mu-MRI) of the radius obtained at 137 x 137 x 350 microm3 voxel size in a cohort of 79 women of widely varying bone mineral density (BMD) and vertebral deformity status. DTA is a new method that allows unambiguous determination of the three-dimensional (3D) topology of each voxel in a trabecular bone network. The analysis involves generation of a bone volume fraction map, which is subjected to subvoxel processing to alleviate partial volume blurring, followed by thresholding and skeletonization. The skeletonized images contain only surfaces, profiles, curves, and their mutual junctions as the remnants of trabecular plates and rods after skeletonization. DTA parameters were compared with integral BMD in the lumbar spine and femur as well as MR-derived bone volume fraction (BV/TV). Vertebral deformities were determined based on sagittal MRIs of the spine with a semiautomatic method and the number of deformities counted after threshold setting. DTA structural indices were found the strongest discriminators of subjects with deformities from those without deformities. Subjects with deformities (n = 29) had lower topological surface (SURF) density (p < 0.0005) and surface-to-curve ratio (SCR; a measure of the ratio of platelike to rodlike trabeculae; p < 0.0005) than those without. Profile interior (PI) density, a measure of intact trabecular rods, was also lower in the deformity group (p < 0.0001). These data provide the first in vivo evidence for the structural implications inherent in postmenopausal osteoporosis accompanying bone loss, that is, the conversion of trabecular plates to rods and disruption of rods due to repeated osteoclastic resorption.

Breast tissue density quantification via digitized mammograms

Studies reported in the literature indicate that breast cancer risk is associated with mammographic densities. An objective, repeatable, and a quantitative measure of risk derived from mammographic densities will be of considerable use in recommending alternative screening paradigms and/or preventive measures. However, image processing efforts toward this goal seem to be sparse in the literature, and automatic and efficient methods do not seem to exist. In this paper, we describe and validate an automatic and reproducible method to segment dense tissue regions from fat within breasts from digitized mammograms using scale-based fuzzy connectivity methods. Different measures for characterizing mammographic density are computed from the segmented regions and their robustness in terms of their linear correlation across two different projections--cranio-caudal and medio-lateral-oblique--are studied. The accuracy of the method is studied by computing the area of mismatch of segmented dense regions using the proposed method and using manual outlining. A comparison between the mammographic density parameter taking into account the original intensities and that just considering the segmented area indicates that the former may have some advantages over the latter.

Artery-vein separation via MRA--an image processing approach

This paper presents a near-automatic process for separating vessels from background and other clutter as well as for separating arteries and veins in contrast-enhanced magnetic resonance angiographic (CE-MRA) image data, and an optimal method for three-dimensional visualization of vascular structures. The separation process utilizes fuzzy connected object delineation principles and algorithms. The first step of this separation process is the segmentation of the entire vessel structure from the background and other clutter via absolute fuzzy connectedness. The second step is to separate artery from vein within this entire vessel structure via iterative relative fuzzy connectedness. After seed voxels are specified inside artery and vein in the CE-MRA image, the small regions of the bigger aspects of artery and vein are separated in the initial iterations, and further detailed aspects of artery and vein are included in later iterations. At each iteration, the artery and vein compete among themselves to grab membership of each voxel in the vessel structure based on the relative strength of connectedness of the voxel in the artery and vein. This approach has been implemented in a software package for routine use in a clinical setting and tested on 133 CE-MRA studies of the pelvic region and two studies of the carotid system from six different hospitals. In all studies, unified parameter settings produced correct artery-vein separation. When compared with manual segmentation/separation, our algorithms were able to separate higher order branches, and therefore produced vastly more details in the segmented vascular structure. The total operator and computer time taken per study is on the average about 4.5 min. To date, this technique seems to be the only image processing approach that can be routinely applied for artery and vein separation.

HIV seropositivity among adult tuberculosis patients in Delhi

We report HIV seropositivity among tuberculosis patients from our hospital between 1994-99. Of the 500 patients with various forms of tuberculosis, two were found to be seropositive (0.4%). This report contrasts with the HIV seropositivity reports from other parts of India where increasing HIV seropositivity has been reported. As the HIV infection is making rapid in-roads in India, it is suggested that continuous HIV sero-surveillance should be done in patients with tuberculosis.

Adrenocortical reserve and morphology in tuberculosis

Ninety seven patients (63 males, mean age 31.8 years, SD 2.3) with various forms of tuberculosis were studied. All of them were HIV negative. Thirty normal control subjects (16 males, mean age 36.4 years, SD 1.8) were also studied. Fifty-eight of the 97 patients (59.8%) were malnourished (BMI < 18 kg/m2). The mean basal serum cortisol was lower in the TB group (n = 91) (351 nmol/1; SD 150) as compared to the normal control group (n = 8) (402 nmol/1; SD 93) but this difference did not attain statistical significance. Following administration of synthetic ACTH (cosyntropin), the 30 and 60 minutes mean serum cortisol values in the TB group were significantly lower as compared to the normal control group (p < 0.05). Forty five of the 91 patients (49.5%) who underwent the ACTH stimulation test had compromised adrenal reserve. Fourteen of the 86 patients (16.3%) in whom adrenal morphology was studied revealed adrenal gland enlargement on abdominal CT scan. ACTH stimulation was done in 12 of these 14 patients and eight of them had compromised adrenal reserve. Repeat ACTH stimulation done six months to one year after treatment in 13 patients revealed significantly increased 30 minutes (p < 0.05) and 60 minutes (p < 0.05) serum cortisol values. While nine of these 13 patients were negative responders before treatment, only three of them had evidence of compromised adrenal reserve after one year of antituberculosis treatment, (p < 0.05). Serum cortisol values in patients with drug-sensitive and drug-resistant tuberculosis did not differ significantly. Patients with drug-resistant tuberculosis had a higher prevalence of adrenal gland enlargement (7 of the 30) as compared to those with drug-sensitive tuberculosis (7 of the 56) (p = NS). Subclinical adrenal insufficiency is prevalent in a significant number of patients with both drug-sensitive and drug-resistant tuberculosis, and in some of these it is associated with adrenal gland enlargement. The compromised adrenal reserve and enlargement seem to reverse with therapy.

Topological analysis of trabecular bone MR images

Recently, imaging techniques have become available which permit nondestructive analysis of the three-dimensional (3-D) architecture of trabecular bone (TB), which forms a network of interconnected plates and rods. Most osteoporotic fractures occur at locations rich in TB, which has spurred the search for architectural parameters as determinants of bone strength. In this paper, we present a new approach to quantitative characterization of the 3-D microarchitecture of TB, based on digital topology. The method classifies each voxel of the 3-D structure based on the connectivity information of neighboring voxels. Following conversion of the 3-D digital image to a skeletonized surface representation containing only one-dimensional (1-D) and two-dimensional (2-D) structures, each voxel is classified as a curve, surface, or junction. The method has been validated by means of synthesized images and has subsequently been applied to TB images from the human wrist. The topological parameters were found to predict Young's modulus (YM) for uniaxial loading, specifically, the surface-to-curve ratio was found to be the single strongest predictor of YM (r2 = 0.69). Finally, the method has been applied to TB images from a group of patients showing very large variations in topological parameters that parallel much smaller changes in bone volume fraction (BVF).

Morphological and cytoskeletal changes caused by non-membrane damaging cytotoxin of Vibrio cholerae on int 407 and HeLa cells

Vibrio cholerae produces a non-membrane damaging cytotoxin (NMDCY), also known as cell rounding factor, which causes rapid rounding of cultured cells like HeLa, CHO and Vero and reportedly elicits enterotoxic activity in the rabbit ileal loop assay. Pursuing the concept that NMDCY might be an accessory factor contributing to the diarrhea caused by V. cholerae, we investigated the effect of NMDCY on Int 407 (intestinal cell line) and HeLa (non-intestinal cell line) cells using light, fluorescent and electron microscopy to gain insight into the cellular response evoked by NMDCY. Binding assays showed that NMDCY has affinity for both Int 407 and HeLa cells. Changes in the internal organelles and cytoskeletal structures of the cell lines were documented indicating changes in the secretory and metabolic function of the toxin-treated cells. Toxin-treated cells visualized under the electron microscope revealed retraction of cell body, formation of blebs on cell surface, changes in mitochondria having dilated and rarefied matrix and an extensively developed Golgi apparatus, endoplasmic reticulum and lysosomes compared to those in normal cells. Immunofluorescence study showed restructuring of microfilament network represented by actin, filamin and vinculin, as also of the microtubular component, tubulin and the intermediate filament, vimentin. Immunogold study further revealed that the toxin is internalized even within the nucleus. Moreover, a rise in the intracellular calcium level of the NMDCY-treated cells leads us to hypothesize that a cascade of events results in the final impairment of the cell machinery.

Evaluation of serum creatine kinase as a diagnostic marker for tubal pregnancy

Forty women comprising of 20 each in study and control groups had their serum creatine kinase (CK) estimated. The study subjects were proven cases of ectopic pregnancy and the controls were either medical termination of pregnancy seekers or antenatal cases matched for gestational age and with a confirmed intrauterine pregnancy. Total serum creatine kinase levels were found to be significantly higher in the study group i.e. 34.15 +/- 1.17 IU/L compared to the controls 18.72 +/- 1.25 (p < 0.001). Creatine kinase is estimated routinely in cardiac patients even on an emergency basis. Our findings indicate that when in doubt the test could be used as a marker for the diagnosis of ectopic pregnancy.

Clonal analysis of non-toxigenic Vibrio cholerae O1 associated with an outbreak of cholera

We examined the clonal relationships among eight clinical isolates of non-toxigenic (NT) V. cholerae O1 associated with a cluster of cases of cholera in Warangal, Andhra Pradesh in south India and compared their relatedness to toxigenic O1 strains of classical and E1Tor biotypes and with O139 Bengal strains of V. cholerae by pulsed-field gel electrophoresis (PFGE). Phylogentic analysis of the NotI restriction fragment length polymorphism showed that all the NT. V. cholerae O1 strains formed a tight cluster with more than 80 per cent similarity. Interestingly, the NT V. cholerae O1 cluster was more closely related to V. cholerae O139 than to classical and E1Tor biotypes of V. cholerae O1 indicating closer genetic relationships between NT V. cholerae 01 and O139 Bengal strains that were isolated during the same time-frame.

Response of wild-type mutants of Vibrio cholerae O1 possessing different combinations of virulence genes in the ligated rabbit ileal loop and in Ussing chambers: evidence for the presence of additional secretogen

Five wild-type mutant strains of Vibrio cholerae serogroup O1 that lacked the CTX virulence cassette, or contained a natural deletion of a virulence gene within the CTX virulence cassette, or possessed an additional virulence gene, along with a prototype toxigenic strain representing the El Tor classical biotypes were examined by in-vivo and in-vitro methods to determine their enterotoxic potential. The ability of whole cells and culture supernates of the strains to cause fluid accumulation in the rabbit ileal loop model revealed a pattern consistent with the presence of the various virulence gene(s), with those possessing the intact CTX virulence cassette being the most secretogenic. Culture supernates of strains without the CTX virulence cassette or the strain with an incomplete cassette were also able to evoke mild to moderate fluid accumulation in the rabbit ileal loop. Of the various media used, AKI and brain heart infusion broth appeared to support the production of a hitherto unknown secretogenic factor, because culture supernates of the non-toxigenic V. cholerae O1 strains showed higher fluid accumulation ratios when grown in these media than in the others. To confirm that the fluid accumulation elicited by these strains in the ileal loop was due to enterotoxin activity, the effect of supernate of the strains was examined in rabbit small intestine mounted on Ussing chambers. Increases in short circuit current and tissue conductance, as compared with the medium control, were observed even with the strains that did not possess the CTX virulence cassette, confirming their ability to disrupt the function of intestinal tissue. From these studies, it was concluded that strains of V. cholerae O1 devoid of the CTX virulence cassette were still able to elicit a secretory response in the ileal loop and displayed enterotoxic activity in an in-vitro experimental model.

Characterization of non-membrane-damaging cytotoxin of non-toxigenic Vibrio cholerae O1 and its relevance to disease

The non-membrane-damaging cytotoxin which causes dramatic cell rounding of cultured HeLa cells was purified to homogeneity from a clinical strain (WO5) of non-toxigenic Vibrio cholerae O1 Inaba belonging to the E1 Tor biotype. The purified protein has a denatured molecular weight of 35 kDa and a native molecular weight of approximately 37 kDa indicating the monomeric nature of the protein. The 15 N-terminal amino acid sequence of non-membrane-damaging cytotoxin showed complete homology to the hemagglutinin protease previously purified and characterized from V. cholerae O1. Purified non-membrane-damaging cytotoxin from V. cholerae O1 was immunologically and biochemically identical to that previously purified from V. cholerae O26. Non-membrane-damaging cytotoxin was found to be enterotoxic in rabbit ileal loop assay inducing accumulation of non-hemorrhagic fluid at 100 micrograms and elicited a concentration dependent increase in short circuit current and tissue conductance of rabbit ileal mucosa mounted on Ussing chambers. A significant serum immunoglobulin G response against non-membrane-damaging cytotoxin was elicited by patients infected with V. cholerae O139 but not with V. cholerae O1. These properties make non-membrane-damaging cytotoxin a potential virulence factor of V. cholerae which should be taken into consideration while making live, attenuated recombinant vaccine strains against cholera.

Production of monoclonal antibodies to the non-membrane-damaging cytotoxin (NMDCY) purified from Vibrio cholerae O26 and distribution of NMDCY among strains of Vibrio cholerae and other enteric bacteria determined by monoclonal-polyclonal sandwich enzyme-linked immunosorbent assay

The distribution of a newly described secretogenic non-membrane-damaging cytotoxin (NMDCY) among strains of Vibrio cholerae and other enteric bacteria was determined. To accomplish this, monoclonal antibodies against NMDCY were prepared and a sandwich monoclonal-polyclonal enzyme-linked immunosorbent assay (ELISA) was developed. By the sandwich ELISA, it was determined that 55.6% of the 412 strains of V. cholerae examined produced NMDCY at varying concentrations while 76, 37.9, and 15.6% of the clinical strains of Vibrio parahaemolyticus, Aeromonas spp., and Shigella spp., respectively, produced NMDCY. Because of its enterotoxigenic potential and based on its widespread distribution among strains of V. cholerae, we believe that NMDCY may constitute an important virulence determinant in the cascade of events which enable the organism to precipitate the disease.

Purification and characterization of an extracellular secretogenic non-membrane-damaging cytotoxin produced by clinical strains of Vibrio cholerae non-O1

Some clinical strains of Vibrio cholerae non-O1 produce an extracellular factor that evokes a rapid and dramatic cytotoxic response which manifests as cell rounding of Chinese hamster ovary (CHO) and HeLa cells without accompanying membrane damage. This study was performed to establish the identity of the non-membrane-damaging cytotoxin (NMDCY), which was not inhibited by antitoxins against cholera toxin, heat-labile toxin of enterotoxigenic Escherichia coli, El Tor hemolysin, Shiga-like toxin I, and Shiga-like toxin II, indicating that NMDCY did not bear an apparent immunological relationship with the above toxins and hemolysin. Brain heart infusion broth and AKI medium supported the maximal production of NMDCY; culture supernatant of AKI medium was found to be free of hemolysin activity, whereas in brain heart infusion broth hemolysin was coproduced with NMDCY. Maximal production of NMDCY in AKI medium was observed at 37 degrees C under shaking conditions with the pH of the medium adjusted to 8.5. NMDCY was purified to homogeneity by a three-step purification procedure which increased the specific activity of the cytotoxin by 1.7 X 10(5)-fold. The denatured molecular weight of the purified toxin was 35,000, and the cytotoxin was heat labile and sensitive to trypsin. Purification of the cytotoxin revealed an enterotoxic activity as reflected by its ability to accumulate fluid in the rabbit ileal loop. Both the cytotoxic and enterotoxic activities of NMDCY could be inhibited or neutralized by antiserum raised against purified cytotoxin but not by preimmune serum. Immunodiffusion test between purified NMDCY and antiserum gave a single well-defined precipitin band which showed reactions of complete identity, while, in an immunoblot assay, a well-defined single band was observed in the 35-kDa region. Our results indicate that the cytotoxic and enterotoxic activities expressed by NMDCY appear to contribute to the pathogenesis of the disease associated with V. cholerae non-O1 strains which produce this cytotoxin.