Recalcitrant ulcerative genital herpes in an immunocompetent individual treated successfully with imiquimod

BACKGROUND

This case report describes the successful use of imiquimod to treat genital herpes in an immunocompetent individual with acyclovir-resistant HSV.

CASE REPORT

A 32 year old male patient, presented with asymptomatic non-healing ulcers over the genital region for 2 years. The ulcers initially responded to acyclovir but became persistent after a few months. He also received multiple courses of antibiotics. On examination, the patient had bilateral inguinal lymphadenopathy and multiple painless ulcers over the coronal sulcus. Routine investigations were normal. The patient was treated with oral and intravenous acyclovir but showed no response. He was then started on topical imiquimod cream applied on alternate days. After one week, the patient presented with pain, redness, burning sensation, and fresh ulcer over the glans which were suspected to be imiquimod-induced irritant reaction or ulcer. Imiquimod was withheld for one week and then restarted at a twice-weekly schedule. After 1 month and 7 days of treatment with imiquimod at a twice-weekly schedule, there was healing of the ulcers.

CONCLUSION

This case report illustrates the efficacy of imiquimod cream as a topical treatment for genital herpes simplex in an immunocompetent patient who had previously been unresponsive to treatment with acyclovir.

Metalloprotein status in Indian patients with beta thalassemia trait

Introduction and Aim: Beta Thalassemia trait (BTT) is the most prevalent heterozygous hemoglobinopathy in Asian population.  The current study aims to evaluate plasma antioxidant metalloproteins like SOD, ceruloplasmin, ferritin and correlate them with the trace elements in patients with BTT.   Materials and Methods: The subjects included in the study were divided into two groups comprising of 40 BTT patients in group I and 40 age and sex matched normal individuals in group II. Cation exchange HPLC was used for hemoglobin variant analysis. Plasma iron, copper, ceruloplasmin and SOD were assayed using the spectrophotometric method while zinc was determined by atomic absorption spectrometry and ferritin by ECLIA.   Results: There was a marked reduction in plasma trace elements in BTT compared to healthy controls. The decrease in zinc (p<0.001) and copper (p<0.04) was statistically significant. Both SOD and ferritin levels were significantly lower in BTT patients (p<0.001). However, an apparent decrease was observed in ceruloplasmin levels. Iron and ferritin showed a significant positive correlation (r=0.84 p=0.01), similarly copper and ceruloplasmin correlated positively (r=0.92 p=0.001) in BTT patients. Interestingly HbF correlated negatively with all the three trace elements.   Conclusion: It can be concluded that decreased antioxidant metalloproteins may lead to free radical toxicity in BTT. The study highlights the indirect role of trace elements in oxidative stress and draws attention on the requirement for regular and timely assessment of metalloenzymes and periodic administration of trace elements in reduction of free radical damage and associated complications in BTT patients.

Trace element status in a rare case of hemoglobin D Punjab trait

Hemoglobin D Punjab is a hemoglobin variant that occurs mainly in northwest India with prevalence rate of 1%. Homozygous form is very rare and clinically more serious than heterozygous HbD. Here we present a case of HbD trait with mild anemia and slightly altered red cell indices in a 31year old female from South India. Decreased plasma trace elements (iron, copper, zinc) and altered metalloproteinsare the novel findings, emphasizing the need for periodic assessment and prompt supplementation of micronutrients to prevent red cell damage and related complications in hemoglobinopathies.  

Ross Syndrome

Ross syndrome is a rare disorder of thermoregulation and includes a triad of tonic pupil, anhidrosis/hypohidosis and areflexia. Here we describe one such case in a 40-year-old woman. A general awareness among physicians, dermatologists and ophthalmologists regarding this disease can alleviate unnecessary anxiety and avoid unnecessary investigations.

Microbiome digital signature of MCR genes - an in silico approach to study the diversity of methanogenic population in laboratory-developed and pilot-scale anaerobic digesters

The production of biogas by anaerobic digestion (AD) of organic/biological wastes has a firm place in sustainable energy production. A simple and cost-effective anaerobic jar at a laboratory scale is a prerequisite to study the microbial community involved in biomass conversion and releasing of methane gas. In this study, a simulation was carried out using a laboratory-modified anaerobic-jar-converted digester (AD1) with that of a commercial/pilot-scale anaerobic digester (AD2). Taxonomic profiling of biogas-producing communities by means of high-throughput methyl coenzyme-M reductase α-subunit (mcrA) gene amplicon sequencing provided high-resolution insights into bacterial and archaeal structures of AD assemblages and their linkages to fed substrates and process parameters. Commonly, the bacterial phyla Euryarchaeota, Chordata, Firmicutes and Proteobacteria appeared to dominate biogas communities in varying abundances depending on the apparent process conditions. Key micro-organisms identified from AD were Methanocorpusculum labreanum and Methanobacterium formicicum. Specific biogas production was found to be significantly correlating to Methanosarcinaceae. It can be implied from this study that the metagenomic sequencing data was able to dissect the microbial community structure in the digesters. The data gathered indicates that the anaerobic-jar system could throw light on the population dynamics of the methanogens at laboratory scale and its effectiveness at large-scale production of bio-methane. The genome sequence information of non-cultivable biogas community members, metagenome sequencing including assembly and binning strategies will be highly valuable in determining the efficacy of an anaerobic digester.

Simultaneous removal of NH4+-N and refractory organics through sequential heterogeneous Fenton oxidation process and struvite precipitation: kinetic study

Graphical representation of integrated HFO and MAP processes.

Biosynthesis of silver nanoparticles from Trichoderma species

A total of 75 isolates belonging to five different species of Trichoderma viz., T. asperellum, T. harzianum, T. longibrachiatum, T. pseudokoningii and T. virens were screened for the production of silver nanoparticles. Although all the isolates produced nanoparticles, T. virens VN-11 could produce maximum nanoparticles as evident from the UV-Vis study. The highest Plasmon band was observed at 420 nm at every 24 h that attained maximum intensity at 120 h (0.543). The high resolution transmission electron microscopy (HRTEM) further provided the morphology of the nanoparticles. These nanoparticles were found single or aggregated with round and uniform in shape and 8-60 nm in size. The nitrate reductase activity of VN-11 was found to be 150 nmol/h/mL which confirmed the production of silver nanoparticles through reduction of Ag+ to Ag0.

DNA sequence variation and haplotype structure of the ICAM1 and TNF genes in 12 ethnic groups of India reveal patterns of importance in designing association studies

We have examined the patterns of DNA sequence variation in and around the genes coding for ICAM1 and TNF, which play functional and correlated roles in inflammatory processes and immune cell responses, in 12 diverse ethnic groups of India. We aimed to (a) quantify the nature and extent of the variation, and (b) analyse the observed patterns of variation in relation to population history and ethnic background. At the ICAM1 and TNF loci, respectively, the total numbers of SNPs that were detected were 28 and 12. Many of these SNPs are not shared across ethnic groups and are unreported in the dbSNP or TSC databases, including two fairly common non-synonymous SNPs at positions 13487 and 13542 in the ICAM1 gene. Conversely, the TNF-376A SNP that is reported to be associated with susceptibility to malaria was not found in our study populations, even though some of the populations inhabit malaria endemic areas. Wide between-population variation in the frequencies of shared SNPs and coefficients of linkage disequilibrium have been observed. These findings have profound implications in case-control association studies.

A case of Kleine-Levin syndrome in India

The Kleine-Levin Syndrome, first categorized by Critchley and Hoffman in 1942, consists of periodic hypersomnia and megaphagia associated with abnormal mental states. Though a case of hypersomnia with doubtful megaphagia was described by J. A. Antimoff as far back as 1898, the first two cases definitely belonging to the syndrome lie hidden in a group of five cases reported by Willi Kleine (1925), a psychiatrist of the Kleist Clinic, Frankfurt, under the title of ‘Periodische Schlafsucht’. The patients were adolescent males who showed periodic hypersomnia with eating of excessive food and an unusual mental state. Writing on narcolepsy, a New York psychiatrist, Max Levin (1929), described a boy who exhibited pathological hunger in association with episodes of sleep of unusual duration. ‘The patient would sleep for long periods at the beginning of each attack. His appetite was enormous. He ate large meals and much in between meals. Max Levin rewrote his original case in 1936, and for the first time made specific mention of a ‘syndrome of periodic somnolence and morbid hunger as a new entity in nosology’ and quoted seven cases as ‘good’ examples of the syndrome.

A case of Gilles de la Tourette's syndrome with some observations on aetiology and treatment

Gilles de la Tourette's syndrome has not been reported outside Europe and America, and all the patients reported have been of the white or negro races (Singer, 1963). Although the condition was described as early as in 1825 by Itard and later differentiated as a syndrome by Gilles de la Tourette (1885), and although the syndrome is an unusual condition with undetermined aetiology, treatment and prognosis (Eisenberg et al., 1959, Kelman, 1965), and Kinnier Wilson (1940) had given the syndrome ‘a sinister’ outlook characteristically ending in insanity, Fernando (1967) could find only 85 cases published in English literature as cases of the syndrome. He rejected 20 cases, and of the 65 ‘proven cases' 50 were from the United States, 13 from Britain, one each from Finland and Canada. Shapiro and Shapiro (1968) commented on the scarcity of the syndrome even in the Western culture. Extensive search in the literature has shown that Gilles de la Tourette's syndrome has not been reported in Asians. This paper presents a detailed report of the first case from India.