Measurement Uncertainty and Validation for Quantitation of Salbutamol in Human Urine by Gas Chromatography-Tandem Mass Spectrometry

A simple, rapid, sensitive and specific gas chromatography-tandem mass spectrometry (GC-MS/MS) method was developed for quantitation of salbutamol in human urine using salbutamol-d3 as the internal standard. The processing of urines samples includes deconjugation with enzymatic hydrolysis, solid phase extraction procedure utilizing XAD2 column and liquid-liquid extraction accompanied by the derivatization by means of MSTFA/IODO-TMS/DTE mixture. The GC column was a HP Ultra-1 (17 m × 0.22 mm × 0.11 μm) used to separate the peak of interest. The data for GC-MS/MS were acquired and processed utilizing GC Labs Solution and Insight GCMS Software. The detection of spectra was performed on TQ 8050. This method included a chromatographic run of 13.67 min and the linearity was found over the concentration range of 250-2000 ng/mL with a regression coefficient (r2) of 0.99. The coefficient of variation for intra and interday assay precision was between 1.85 and 2.85% and the accuracy was between 95.50 and 107.04% for low quality control (QC), medium QC and high QC. The recovery was adequate to reliable detect the analyte at or below the level recommended by the World Anti-Doping Agency i.e., threshold 1000 ng/mL. The limit of detection and limit of quantification were found to be 10 and 100 ng/mL, respectively. The expanded measurement uncertainty (Uexp%) was found to be 8.28%.

Prevalence of double diabetes in youth onset diabetes patients from east Delhi and neighboring NCR region

BACKGROUND

It is being increasingly reported that some of the youth onset diabetes patients cannot be classified clearly as type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on usual criteria and the term double diabetes (DD) coined for these cases.

AIM

The objective of the study was to find out the prevalence of DD in youth onset diabetes patients from east Delhi and neighboring NCR region.

METHODS

A total of 200 patients with youth onset diabetes below 25 years of age were recruited from a tertiary care hospital in East Delhi. Clinical history, family history of diabetes and anthropometry of patients were recorded. Fasting serum C-peptide, Anti-IA2-antibody and Anti-GAD-antibody were measured in all patients. Patients positive for Anti-GAD-antibody (>1.05U/ml) and C-peptide level >0.3nmol/l were characterized as DD patients. Patients negative for Anti-GAD-antibody and C-peptide >0.3nmol/l were kept under the category of T2DM. Patients with low C-peptide level along with one of the following, positive Anti-GAD-antibody, positive Anti-IA2-antibody and diabetic ketoacidosis (DKA) were considered as T1DM. Remaining patients were kept under the unknown category.

RESULTS

Mean age of study subjects was 18.2±7.1years. Seven percent (7%) of the subjects were classified as DD, 51% as T1DM, 13% as T2DM and 29% were kept under the unknown category. Mean age of subjects with 22.2±9.7, 16.9±6.7, 20.6±7.7 and 19.4±7.4 years in DD, T1DM, T2DM and unknown category respectively. Mean BMI of subjects with DD, T1DM, T2DM and unknown category was 19.8±5.7, 16.6±3.7, 19.3±4.1 and 18.0±4.6 kg/m² respectively.

CONCLUSION

Double diabetes is an important occurrence among youth onset diabetes subjects. Only half of the subjects with youth onset of diabetes had T1DM.

High prevalence of obesity among nursing personnel working in tertiary care hospital

AIM

To find out the prevalence of obesity and glucose intolerance among nurses working in tertiary care hospital.

METHODS

Study was conducted in 496 apparently healthy females comprising two groups. Group B had 290 nurses and control group A had 206 age matched female subjects of general population. Detailed performa was filled which included anthropometry, systemic examination and other details. Fasting plasma glucose was done followed by oral glucose tolerance test (OGTT). Subjects with body mass index ≥23 kg/m² were categorized as 'overweight' and ≥25 kg/m² as 'obese' as per criteria for Asian Indians. Women with waist circumference of ≥80 cm were categorized as 'centrally obese'.

RESULTS

Mean age of subjects in groups A and B was 40.45 ± 8.64 years and 40.50 ± 6.96 years respectively. Significantly higher number of nurses (80%) were overweight or obese compared to controls (59.71%,P = < .001). Similarly, central obesity was significantly higher in nurses (82.07%) compared to controls (67.96%,P = <.001). The prevalence of glucose intolerance (prediabetes and newly detected diabetes) was significantly higher in controls compared to nurses (45.63% vs 29.66%, P < .001).

CONCLUSION

Every four out of five nurses working in tertiary care hospital have overweight/obesity and central obesity. Despite this they have lower rates of glucose intolerance.

Synthesis of stable benzimidazole derivatives bearing pyrazole as anticancer and EGFR receptor inhibitors

A new series of benzimidazole linked pyrazole derivatives were synthesized by cyclocondensation reaction through one-pot multicomponent reaction in absolute ethanol. All the synthesized compounds were tested for their in vitro anticancer activities on five human cancer cell lines including MCF-7, HaCaT, MDA-MB231, A549 and HepG2. EGFR receptor inhibitory activities were carried out for all the compounds. Majority of the compounds showed potent antiproliferative activity against the tested cancer cell lines. Compound 5a showed the most effective activity against the lungs cancer cell lines (IC₅₀ = 2.2 µM) and EGFR binding (IC₅₀ = 0.97 µM) affinity as compared to other members of the series. Compound 5a inhibited growth of A549 cancer cells by inducing a strong G₂/M phase arrest. In addition, same compound inhibited growth of A549 cancer cells by inducing apoptosis. In molecular docking studies compound 5a was bound to the active pocket of the EGFR (PDB 1M17) with five key hydrogen bonds and two π-π interaction with binding energies ΔG = -34.581 Kcal/mol.

Pyridazinone hybrids: Design, synthesis and evaluation as potential anticonvulsant agents

A series of new hybrid benzothiazole containing pyridazinones derivatives were designed and synthesized fulfilling all the pharmacophoric requirements essential for the anticonvulsant activity. In-silico and in vitro studies revealed that some of these hybrid derivatives demonstrated admirable GABA AT inhibitory activity. An attempt has also been made to validate the results of in vitro GABA AT inhibition of the most potent compound SPS-5F (IC₅₀ 9.10 μM) through in vivo anticonvulsant screening. Compound SPS-5F administration significantly increases the whole brain GABA level, might be through the inhibition of GABA AT enzyme.

Synthesis and characterization of novel carboxymethyl Assam Bora rice starch for the controlled release of cationic anticancer drug based on electrostatic interactions

Carboxymethyl Assam Bora rice starch (CM-ABRS) was chemically synthesized in non-aqueous medium with the optimum degree of substitution (DS) of 1.23, and physicochemically characterized by FT-IR, DSC, XRD, and SEM analysis. Comparative evaluation of CM-ABRS with native starch (ABRS) for powder flow characteristics, swelling index, apparent solubility, rheological properties, textural properties, and mucoadhesive studies were carried out. The aim of the current work was to investigate the potential of CM-ABRS as a novel carrier for the water-soluble chemotherapeutic, doxorubicin hydrochloride (DOX). Formation of drug/polymer complex (DOX-CM-ABRS) via electrostatic interaction has been evaluated for the controlled release of DOX in three different pH media (phosphate-buffered saline (PBS), pH 7.4, 6.8, and 5.5). In vitro drug release studies illustrated faster release of drug in PBS at pH 5.5 as compared to pH 6.8 and pH 7.4, respectively, indicating the importance of pH-sensitive drug release from the DOX-CM-ABRS complex in malignant tissues.

Risk factors involved in spread of HCV in patients from sub urban Rawalpindi and their association with existing genotypes

The current epidemiological study was designed to trace the involved risk factors in Hepatitis C Virus (HCV) spread and to identify any association between HCV genotypes and risk factors. Blood samples were taken from 400 participants and viral genotyping was performed in order to find any possible relationship between the risk factors and genotypes. Major genotypes included 3, 1, 4 and several untypeable ones with prevalence rates 65%, 22.5%, 2.75% and 9.75% respectively. Surgery and dental procedure were strongly related to the spread of genotype 3b, while genotype 1b was strongly related to blood transfusion and dental procedures as a single combination risk factor. On the other hand genotypes 1a, 3a, 4 and the untypeable genotypes, were equally affected by all reported risk factors. The probability of occurrence of genotype 3a with reference to dental procedures was 11%. Dental procedures, unsafe injection and surgical procedures are the main risk factors while the blood transfusion in combination with dental procedures has emerged as a potent risk factor in the transmission of HCV.

Pharmacological properties of Datura stramonium L. as a potential medicinal tree: an overview

India has a great wealth of various naturally occurring plant drugs which have great potential pharmacological activities. Datura stramonium (D. stramonium) is one of the widely well known folklore medicinal herbs. The troublesome weed, D. stramonium is a plant with both poisonous and medicinal properties and has been proven to have great pharmacological potential with a great utility and usage in folklore medicine. D. stromonium has been scientifically proven to contain alkaloids, tannins, carbohydrates and proteins. This plant has contributed various pharmacological actions in the scientific field of Indian systems of medicines like analgesic and antiasthmatic activities. The present paper presents an exclusive review work on the ethnomedical, phytochemical, pharmacological activities of this plant.

Biodegradation and flushing of MBT wastes

Mechanical-biological treatment (MBT) processes are increasingly being adopted as a means of diverting biodegradable municipal waste (BMW) from landfill, for example to comply with the EU Landfill Directive. However, there is considerable uncertainty concerning the residual pollution potential of such wastes. This paper presents the results of laboratory experiments on two different MBT waste residues, carried out to investigate the remaining potential for the generation of greenhouse gases and the flushing of contaminants from these materials when landfilled. The potential for gas generation was found to be between 8% and 20% of that for raw MSW. Pretreatment of the waste reduced the potential for the release of organic carbon, ammoniacal nitrogen, and heavy metal contents into the leachate; and reduced the residual carbon remaining in the waste after final degradation from ∼320g/kg dry matter for raw MSW to between 183 and 195g/kg dry matter for the MBT wastes.

Quantifying the effect of settlement and gas on solute flow and transport through treated municipal solid waste

The effect of degradation and settlement on transport properties of mechanically and biologically treated (MBT) waste was examined by applying three different tracers to two waste columns (~0.5 m diameter) in a series of closed-loop experiments. One column was allowed to biodegrade and the other was bio-suppressed. Permeability and drainable porosity were reduced by settlement, in line with previous results. A dual-porosity model performed well against the data and suggested that more preferential flow occurred early on in the un-degraded column. Diffusion timescales were found to be between 0.8 and 6 days. Volumetric water contents of the mobile region were found to be small in the bio-suppressed cell (~0.01) and even smaller values were found in the degrading waste, possibly due to displacement by gas. Once either settlement or gas production had disrupted this pattern into a more even flow, subsequent compression made little difference to the diffusion time-scale. This may indicate that transport was thereafter dominated by other aspects of the waste structure such as the distribution of low-permeability objects. The presence of gas in the degrading waste reduced the volumetric water content through displacement. The model indicated that the gas was primarily located in the more mobile porosity fraction. Primary compression of the degrading waste tended to squeeze this gas out of the waste in preference to water.

Investigations into the landfill behaviour of pretreated wastes

Mechanical-biological treatment of municipal solid waste has become popular throughout the UK and other parts of Europe to enable compliance with the Landfill Directive. Pretreatment will have a major influence on the degradation and settlement characteristics of the waste in landfills owing to the changes in the composition and properties of the wastes. This paper presents and compares the results of long term landfill behaviour of the UK and German MBT wastes pretreated to different standards. The gas generating potential, leachate quality and settlement characteristics are highlighted. The results reveal that it is possible to achieve stabilisation of MBT waste within a year and the biogas yield and leachate strength of German MBT waste was significantly reduced compared with the UK MBT waste. The settlement resulting from mechanical creep is more significant than the biodegradation induced settlement in both cases.

Sm-p80-based DNA vaccine made in a human use approved vector VR1020 protects against challenge infection with Schistosoma mansoni in mouse

Although there is an effective drug (praziquantel) available for the treatment of schistosomiasis, yet the disease is still spreading unabated and is rampant in 76 countries. Control via praziquantel treatment has so far been insufficient in reducing the disease transmission. Therefore, a vaccine in addition to other strategies, for example, improving sanitation and introduction of new drugs are essential to successfully control and eventually eradicate schistosomiasis. To this effect, we have targeted a functionally important antigen, Sm-p80 as a vaccine candidate. In this study, full length cDNA of Sm-p80 was cloned in VR1020, a FDA approved vector for human use. The protective efficacy of this vaccine formulation was tested in a murine model. Sm-p80-VR1020 vaccine formulation was able to induce 47% reduction in worm burden. Serology on samples obtained from vaccinated animals revealed a strong antibody response which included IgG and all of its subtypes, IgM and IgA. Proliferating splenocytes in response to recombinant Sm-p80 produced a wide spectrum of cytokines representing Th1, Th2 and Th17 types, as ascertained via RT-PCR analysis. These findings further strengthen the importance of Sm-p80 molecule as a vaccine candidate for intestinal schistosomiasis.

Integument of the tapeworm scolex. 1. Freeze-fracture of the syncytial layer, microvilli and discoid bodies

The tegument of cestodes is the most important and structurally complex metabolic interface between these parasites and the hostile environment in which they reside. In spite of the complex metabolic, regulatory and immunological properties of this layer of syncytial cytoplasm, which are relatively well known, the detailed fine structural anatomy of the cestode tegument remains equivocal. The present study therefore reports the freeze-fracture morphology of the tapeworm (Hymenolepis diminuta) tegument. The most important features revealed by analysis of platinum replicas of freeze-fractured tapeworm scolex-neck tegument include: (a) presence of highly ordered linear and/or circumferentially-orientated rows of intramembrane particles situated on the PF fracture face of microvillar plasma membrane, which may participate in movements of the microvilli, (b) presence of apparent 'pores' (11 nm in diameter) at the tips of the tegumentary microvilli, which could serve as regulated gates through which extramicrovillar surface coating materials can be extruded, and (c) the alignment of cytoplasmic discoid bodies into positions at the bases of the surface microvilli such that they could move into the core of each microvillus and thereby release their contents for extrusion (via the pores) onto the outer surface of the microvilli. Concomitantly, the limiting membrane of the discoid bodies could be added to the tegument plasma membrane and thereby contribute to the rapid turnover of the tegumentary surface. This study provides the first detailed account of the ultrastructural anatomy of the tapeworm tegument and is intended to serve as a point of reference for future investigations of tapeworm tegumentary functions.

Sm-p80-based DNA vaccine formulation induces potent protective immunity against Schistosoma mansoni

No effective vaccine exists for the human parasitic disease, schistosomiasis. We have targeted a functionally important antigen, Sm-p80 as a vaccine candidate because of its consistent immunogenicity, protective potential and important role in the immune evasion process. In this study we report that a Sm-p80-based DNA vaccine formulation confers 59% reduction in worm burden in mice. Animals immunized with Sm-p80-pcDNA3 exhibited a decrease in egg production by 84%. Sm-p80 DNA elicited strong immune responses that include IgG2A and IgG2B antibody isotypes in vaccinated animals. Splenocytes proliferated in response to Sm-p80 produced appreciably more Th1 response enhancing cytokines (IL-2, IFN-gamma) than Th2 response enhancing cytokines (IL-4, IL-10). These data reinforce the potential of Sm-p80 as an excellent vaccine candidate for schistosomiasis.

Self-expanding plastic esophageal stents versus jejunostomy tubes for the maintenance of nutrition during neoadjuvant chemoradiation therapy in patients with esophageal cancer: a retrospective study

In patients undergoing chemoradiotherapy for esophageal cancer, the inability to eat may severely impair nutritional status. We conducted a retrospective study to compare the efficacy of the Polyflex self-expanding silicone stent (PS) versus a jejunostomy tube (JT) for maintaining nutrition during neoadjuvant chemoradiation therapy in patients with esophageal cancer who were scheduled for resectional surgery. Thirty-six patients were treated either with PS placement (12 patients) or JT placement (24 patients) prior to receiving an 8-week course of chemoradiation therapy. Patients were interviewed weekly until cessation of therapy. Patient data were collected on procedural success and complication rates, nutritional status, and dysphagia scores. PS placement was successful in 11 of 12 patients (92%), and those 11 patients were able to resume oral nutrition. Dysphagia scores improved from a mean of 3 to 1 in the PS group (P < 0.005) but did not change significantly in the JT group. PS were removed endoscopically without complications prior to the esophagectomies. Albumin levels and weight increased significantly in both the PS and JT groups. There were no significant differences between groups in the procedural success rates (PS 92% vs. JT 100%, P = 0.33), complication rates (PS 22% vs. JT 4%, P = 0.11), mean increase in weight (PS 4.4 kg vs. JT 4.2 kg, P = 0.59), and mean increase in serum albumin (PS 0.62 g/dL vs. JT 0.44 g/dL, P = 0.05). PS is a safe and effective alternative to a surgical JT for maintaining nutrition in this subset of patients.

Enhanced detection rate of typhoid fever in children in a periurban slum in Karachi, Pakistan using polymerase chain reaction technology

OBJECTIVE

Yield of blood culture in clinically suspected cases of typhoid fever is low, whereas indirect serological diagnostic tests are unreliable. Hence, polymerase chain reaction (PCR)-based detection of Salmonella enterica Serovar typhi was used as an aid for diagnosis of typhoid fever in addition to other diagnostic tests. Two periurban communities in Karachi were selected for an epidemiological study of typhoid fever. The aim of the study was to assess whether PCR increased the detection rate of typhoid fever in children in the community.

MATERIAL AND METHODS

Children aged 2 to 14 years presenting with fever lasting for three or more days were selected. PCR using Hashimoto's protocol based on ViaB gene sequence was used in addition to blood culture and other serological tests.

RESULTS

Of the 214 children included in the study, blood culture was found positive for S. enterica S. typhi in 26 (12.4%) cases, whereas 24 children (11.7%) were diagnosed as suffering from typhoid fever when the PCR-based method was used. Both tests were positive in only 10 (4.9%) children. The number of children found positive for either test was 40. PCR increased the rate of detection of typhoid fever by 51%.

CONCLUSION

The sensitivity, specificity, +ve and -ve predictive values of PCR in this study were 40%, 93%, 45% and 92%, respectively.

Determinants of compliance with colonoscopy in patients with adenomatous colon polyps in a veteran population

AIM

To determine factors affecting compliance of a follow-up colonoscopy in patients with previously diagnosed adenomatous colon polyps.

METHODS

A retrospective review was performed on patients with adenomatous polyps excised between January and December 1998. Twenty-nine clinical factors were assessed in patients grouped into whether they were compliant (n = 81) or noncompliant (n = 38) with follow-up colonoscopy. Significant variables by univariate analysis were included in multivariate regression.

RESULTS

One hundred and nineteen patients with adenomatous colon polyps were identified. Of 119 patients, 114 had a documented recommendation for follow-up of 5 years or less, with 69% having been compliant. In a univariate analysis, greater number of polyps (P = 0.04), NSAID use (P = 0.02), statin use (P = 0.005), first-degree relatives with colon cancer (P = 0.05) and compliance with out-patient clinic follow-up (P < 0.001) were significantly associated with patient compliance. Multivariate analysis revealed statin use (P = 0.05), first-degree relatives with colon cancer (P = 0.06) and compliance with out-patient clinic follow-up (P < 0.001) were independent predictors of compliance.

CONCLUSIONS

History of statin use and family history of colon cancer are good predictors of compliance. The strongest predictor can be anticipated with compliance assessed with encounters for other visits. Strong efforts should be directed at improving patient education about colon cancer by the physician and facilitating patient compliance.

Measurement and significance of 3-nitrotyrosine in systemic lupus erythematosus

Nitration of free and protein associated tyrosine represents, in vivo, a mechanism that can severely compromise the cell function. The detection of 3-nitrotyrosine (3-NT) in pathological tissues is suggestive of the occurrence of nitrating pathways and has been identified as a marker of inflammation and a stable end product of increased reactive nitrogen intermediate production. Protein nitration occurs in many disease conditions including systemic lupus erythematosus (SLE). In this study we show that the level of both free and protein bound 3-NT, which is produced by reactive nitrogen species (RNS)-dependent oxidative damage, is elevated in patients with SLE and that there is a possible role of RNS-modified epitopes in the aetiology of the disease. Commercially available poly L-tyrosine was exposed to nitrating species, inducing nitration in tyrosine residues. Immunoglobulin-G (IgG) purified on Protein-A-Sepharose matrix from 24 SLE patients was studied for their recognition of native and nitrated poly L-tyrosine by direct binding and competition enzyme-linked immunosorbent assay (ELISA). The formation of immune complex between SLE IgG and nitrated poly L-tyrosine was visualized by gel retardation assay. Free 3-NT in patients' sera was detected and quantitated by high performance liquid chromatography whereas protein-bound 3-NT was analysed by Western blotting and the concentration was calculated by sandwich ELISA. The concentration of free 3-NT was found to be 1.4 +/- 0.09 microm whereas the concentration of protein bound 3-NT was 96.52 +/- 21.12 microm nitrated bovine serum albumin equivalents/mg protein, which was significantly higher when compared with healthy controls. Elevated level of 3-NT was observed in SLE patients using two different techniques, when compared with healthy subjects confirms the overproduction of RNS in the pathogenesis of human SLE.

Endoscopic sphincterotomy with or without cholecystectomy for choledocholithiasis in high-risk surgical patients: a decision analysis

BACKGROUND

Laparoscopic cholecystectomy (LC) is recommended for patients with choledocholithiasis after ERCP with sphincterotomy (ES) and stone extraction.

AIM

We designed a decision model to address whether ES alone versus ES followed by LC (ES + LC) is the optimal treatment in high-risk patients with choledocholithiasis.

METHODS

Our cohort were patients with obstructive jaundice who have undergone an ES with biliary clearance. Recurrent biliary complications over a 2-year period stratified by gallbladder status (in/out) and age-stratified surgical complication rates were obtained from the literature. Failure of therapy was defined as either recurrent symptoms or death attributed to biliary complications.

RESULTS

For age 70-79 years, ES failed in 15% whereas ES + LC failed in 17% of cases. Mortality in the EC + LC group was 3.4 times that of the ES alone cohort. For age 80+ years, ES was dominant with an incremental success rate of 8%. Mortality in the ES + LC was 7.6 times that of ES. For age <70, ES + LC was the dominant strategy with an incremental success rate 5%. Sensitivity analysis in the groups confirmed our conclusions.

CONCLUSIONS

Management of choledocholithiasis by ES and stone clearance, but without cholecystectomy, should be considered for patients aged 70+. For low-risk patients, ES + LC should be performed to prevent recurrent biliary complications.

Synthesis and evaluation of phenoxy acetic acid derivatives as anti-mycobacterial agents

In present investigation, 2-(4-formyl-2-methoxyphenoxy) acetic acid on condensation with various ketones in methanolic KOH solution yielded the corresponding chalcones (1-3). These corresponding chalcones were reacted with appropriate acid hydrazide in glacial acetic acid led to the formation of phenoxy acetic acid derivatives. All newly synthesized compounds were evaluated for their anti-mycobacterial activities against Mycobacterium tuberculosis H(37)Rv.

Correlation between translation efficiency and outcome of combination therapy in chronic hepatitis C genotype 3

Combination therapy with interferon-alpha (IFN-alpha) and ribavirin (RBV) in chronic hepatitis C demonstrates the best responses against hepatitis C virus (HCV) of genotype 3. Still, it has proven to be ineffective in 20-30% of patients infected with this genotype. In the present study, we analysed the translation efficiency mediated by the internal ribosome entry site (IRES) region in HCV genotype 3 genomes isolated from sustained responders (SR) and non-responders (NR), assuming that this may influence the outcome of treatment. Pretreatment isolates of genotype 3 from 22 individuals (15 SR, seven NR) were selected for such analyses. The IRES region [nucleotide (nt) 1-407] was cloned into a dual luciferase vector and IRES activity assessed following transfection into various cell lines. Low relative translation efficiency was observed for IRES elements derived from SR patients, whereas those of NR patients showed significantly greater translation efficiency (29.7 +/- 13 vs 69.4 +/- 22; P < 0.01). Subsequently, the effect of IFN-alpha plus RBV on IRES-driven translation in vitro was determined. A greater suppressive effect was observed on IRES activity isolated from seven SR patients, when compared with seven NR patients. In conclusion, IRES efficiency in vitro correlated with treatment response for HCV genotype 3. Further studies are warranted to investigate whether IRES efficiency in vitro, or sequence motifs associated with IRES efficiency, will be worthwhile to explore as prognostic tools for other HCV genotypes in the treatment of chronic HCV infection.

Diagnostic MR imaging features of craniocerebral Aspergillosis of sino-nasal origin in immunocompetent patients

BACKGROUND

Craniocerebral invasive Aspergillosis of sino-nasal origin has been reported with a very high mortality due to a peculiarly fulminant clinical course. Early diagnosis based on clinical radiological imaging may have an impact on final clinical outcome. This retrospective study focuses on characteristic MR imaging features of Aspergillosis (of sinonasal origin) in immunocompetent patients.

METHODS

Medical records of patients were reviewed retrospectively during the period from 1991 to 2003 in the two tertiary care hospitals. All the patients had radiological evidence of disease in the paranasal sinuses with or without intracranial extension. Immunocompetence of patients was assessed on clinical and radiological data. MRI scans (n=20) were reviewed by both clinical neurosurgeons and neuroradiologists separately. MRI was done on 1.5 tesla scanners and both T2-weighted and T1 weighted sequences were obtained followed gadolinium enhanced images. Patients were categorized into three types based on their anatomical location on MRI scans; type-1 being intracerebral, type-2 as intracranial extradural and type-3 invading orbit and/or skull base only. All these patient had the epicenter of disease in the nose and/or paranasal sinuses as evident on MR imaging. All patients underwent standard surgical intervention followed by antifungal therapy. Clinical outcome was assessed on Glasgow outcome scale with mean duration of clinical follow up of 13.9 months.

FINDINGS

Mean age of patents (n=20) was 31.1 years with male preponderance (3:1). MRI scans showed evidence of disease in paranasal sinuses including mucosal thickening (n=11) and complete filling of sinuses (n=9). T2-weighted images showed extremely hypo-intense fungal mass (n=19) while T1-weighted images had iso-intense signals (n=18). Gadolinium-enhanced images showed bright homogenous contrast enhancement (n=18) and peripheral ring enhancement pattern (n=2). All patients underwent appropriated surgical procedures depending upon anatomical location followed by standard antifungal therapy. Tissue diagnoses were established by histopathology (n=20) and culture growth (n=5). Overall mortality remained 15 percent.

INTERPRETATION

Craniocerebral Aspergillosis of sinonasal origin has typical MR imaging features. These features include a mass lesion producing hypo-to-iso-intense signals on T1-weighted, extremely low signals (hypo-intense) on T2-weighted images, with bright homogenous enhancement on post-gadolinium T1-weighted imaging. These features in the clinical background may be helpful in early diagnosis and management of Aspergillosis of sino-nasal origin in immunocompetent hosts. Prospective clinical study is required to make firm clinical therapeutic recommendations.

Characterization of protective immunity induced against Schistosoma mansoni via DNA priming with the large subunit of calpain (Sm-p80) in the presence of genetic adjuvants

Despite advances in control via snail eradication and large-scale chemotherapy using praziquental, schistosomiasis continues to spread to new geographic areas particularly in sub-Saharan Africa. Presently, there is no vaccine for controlling this disease. We have concentrated on a functionally important schistosome antigen Sm-p80 as a possible vaccine candidate for schistosomiasis. Here we report the proliferation of spleen cells in response to the recombinant Sm-p80 protein and cytokine (IFN-gamma and IL-4) production by the splenocytes. These spleen cells were obtained from groups of mice that were vaccinated with a DNA vaccine formulation containing Sm-p80 and one of the Th-1 (IL-2 or IL-12) or Th-2 (GM-CSF, IL-4) enhancer cytokines. The splenocytes from the groups of mice vaccinated with Sm-p80 DNA in the presence of Th-2 enhancer cytokines showed moderate but detectable proliferation. The splenocytes obtained from mice vaccinated with Sm-p80 DNA with Th-1 enhancer cytokines IL-2 and IL-12 provided the highest proliferation. The IFN-gamma production by splenocytes was found to follow the similar pattern [(Sm-p80) < (Sm-p80 + IL-4) < (Sm-p80 + GMCSF) < (Sm-p80 + IL-12) < (Sm-p80 + IL-2)], as has been observed for the proliferation and protection data. However, the elevated IL-4 production was inversely correlated to Sm-p80-induced splenocyte proliferation or the protection. These results show again that protective immune response induced by Sm-p80 is of Th-1 type.

Regulation of gene expression in parasitic flatworms

Transcriptional regulation and the role of transcription factors are widely regarded to be the major contributors controlling gene expression in eucaryotes. Translational control is less well understood due to the complexity of the components involved in regulation of protein synthesis at this level. Nevertheless, considerable advances have been made recently in elucidating the major controlling factors within the messenger RNA (mRNA) sequence and the translation machinery. In this article, Ron Podesta and Afzal Siddiqui suggest that protein synthesis in flatworm parasites is controlled post-transcriptionally and that these intracellular regulatory mechanisms are activated/suppressed by effectors of the host's immune response.

Experimental analysis of screw hold as judged by operators v pullout strength

An analysis of the accuracy of the operators' assessments of the hold of bone screws is reported. These assessments of screw hold were compared with measurements from pullout testing. Four operators, encompassing a range of experiences in terms of screw insertion, prepared the pilot holes, and inserted a number of screws, assigning each with a score from 0 to 10 on the basis of how good the hold was felt to be. The pullout strength for each screw was then measured using a tensometer. The results were analysed and correlation coefficients calculated. Significant correlation was observed in all four subjects, with P < 0.001 in two out of the four subjects, and 0.01 > P > 0.001 in the other two. The conclusions were that there is a strong correlation between the subjective assessment of screw hold and actual pullout strength within the four subjects analysed.

Complete surgical excision of intramedullary schwannoma at the craniovertebral junction in neurofibromatosis type-2

Intramedullary spinal schwannomas are extremely rare. We describe a case of a 13-year-old female who was found to have an intramedullary schwannoma at craniovertebral junction along with incidental bilateral acoustic neuromas, which was excised completely. To our knowledge, this is the first report of a case of intramedullary schwannoma in association with NF-2 located at the craniovertebral junction. The literature has been reviewed with emphasis on radiological imaging, histopathological diagnosis and technique to achieve complete microsurgical excision.

Cage versus tricortical graft for cervical interbody fusion

We conducted a prospective, randomised study of 42 cervical interbody fusions undertaken with either an autologous tricortical graft or a cage. The factors assessed in the two groups were: (1) time taken to achieve fusion; (2) neck disability index; (3) pain score; (4) interbody height ratio; (5) interbody angle and (6) the influence of smoking on fusion.

No statistical difference was seen in the time taken to achieve fusion, neck disability index, interbody height ratio, or interbody angles. Smoking did not have any effect on the fusion process. The pain score was significantly lower in the tricortical graft group at six months. We conclude that both methods of fusion give similar results, although tricortical graft fusion is cheaper than cage fusion, and is more effective in reducing the pain score.

Posterior sternoclavicular joint dislocation: the value of intra-operative ultrasound

The sternoclavicular joint dislocates posteriorly if the costoclavicular ligaments, posterior capsule, and anterior capsule have all been disrupted. Diagnosis of a posteriorly dislocated sternoclavicular joint is difficult on clinical examination and with plain X-rays. The treatment objective is to obtain a closed reduction, and failing this an open reduction is indicated. In the intra-operative setting the evaluation of the reduction when performed through closed means can be somewhat difficult, and intra-operative plain films do not give clear answers. Ultrasound as an imaging modality for these injuries was shown to demonstrate the state of the joint in terms of reduction, more clearly than X-rays (P<0.001). It was accurately interpreted by the vast majority of orthopaedic surgeons in an investigation, and is of great value in the intra-operative setting to confirm whether a closed reduction has been successful or not. A case is reported illustrating its use.

Determination of alpha-1 antitrypsin genetic deficiency in duodenal ulcer by polymerase chain reaction

OBJECTIVE

To confirm alpha-1-AT deficiency status in duodenal ulcer using a combination of PCR and restricted enzyme digestion.

METHODS

Fifty patients with endoscopically proven duodenal ulcer and hundred controls with no signs of the disease were included. Alpha-1-AT phenotypes were confirmed by polymerase chain reaction followed by restriction enzyme digestion.

RESULTS

Alpha-1-AT concentration in duodenal ulcer patients showed a mean value of 2.12 +/- 0.11 g/l (range: 0.52-3.95 g/l, p < 0.05). In controls this was 2.47 +/- 0.08 g/l (range: 0.52-5.0 g/l). Among the controls 70% had the MM phenotype, 28% M1 M2 and 2% FM. In duodenal ulcer, MM predominates (70%), followed by M1 M2 (18%), SS (4%), SZ (4%), ZZ (2%) and MZ (2%).

CONCLUSION

Alpha-1 AT deficiency was found in 10% of duodenal ulcer patients. DNA analysis more accurately resolved the phenotypes as S and Z mutations.

Predictors of mortality in brain abscess

OBJECTIVE

Brain abscess carries significant morbidity and mortality. Our objective was to elucidate the clinical presentation of brain abscess and to assess predictors of mortality in these patients.

METHODS

All patients with a brain abscess presenting to the Aga Khan University Hospital, a tertiary care referral center in Karachi, Pakistan, were studied retrospectively. Statistical analysis involved univariate analysis and a logistic regression model.

RESULTS

Among the 66 patients analyzed, a distant metastatic focus of infection was the most commonly identified predisposing factor (29%). Otogenic infection was the commonest contiguous source and sinusitis was noticeably absent. Multiple abscesses were frequent (35%). Streptococci were the most common isolates (39%). Lumbar puncture was performed in 44% and steroids administered in 33%. Treatment was surgical in 58%. Most comatose patients were treated conservatively. Overall mortality was 29%. Univariate analysis identified comatose presentation and identification of a distant focus of infection as predictors of mortality. The logistic regression model, however, identified a distant focus of infection as the only independent predictor.

CONCLUSION

Age greater than 30 years, corticosteroid use, multiple abscesses, performance of lumbar puncture and conservative management had no affect on outcome.

Immediate loading of dental implants in the edentulous mandible: a preliminary case report from an international prospective multicenter study

The ability to predictably achieve long-term osseointegration in patients with compromised anatomical resources has been demonstrated numerous times in modern oral implantology. Recently, clinical attention has focused on new methods of reducing treatment time. One-stage surgical procedures and immediate loading of implants at the time of placement are two techniques that have demonstrated promising clinical results. A prospective clinical study of immediately splinting and loading a new, one-stage implant is currently in progress in the United States and France. An overview of the implant design and presentation of one case study from the University of Pittsburgh demonstrates how this promising technique is performed.

Diagnosis of Strongyloides stercoralis infection

Strongyloides stercoralis infects 30 million people in 70 countries. Infection usually results in asymptomatic chronic disease of the gut, which can remain undetected for decades. However, in patients receiving long-term corticosteroid therapy, hyperinfection can occur, resulting in high mortality rates (up to 87%). Strongyloidiasis is difficult to diagnose because the parasite load is low and the larval output is irregular. Results of a single stool examination by use of conventional techniques fail to detect larvae in up to 70% of cases. Several immunodiagnostic assays have been found ineffective in detecting disseminated infections and show extensive cross-reactivity with hookworms, filariae, and schistosomes. Although it is important to detect latent S. stercoralis infections before administering chemotherapy or before the onset of immunosuppression in patients at risk, a specific and sensitive diagnostic test is lacking. This review describes the clinical manifestations of strongyloidiasis, as well as various diagnostic tests and treatment strategies.

Neoplastic growth of cerebral cavernous malformation presenting with impending cerebral herniation: a case report and review of the literature on de novo growth of cavernomas

BACKGROUND

Cerebral cavernomas are rare vascular anomalies and their expansile growth has been considered to be mainly due to recurrent hemorrhages. They are not generally reported to show aggressive behavior.

CASE DESCRIPTION

A 27-year-old male presented with headache, visual disturbances, and a 17-year history of seizures. He was known to have a temporal lobe lesion on CT scan, consistent with a diagnosis of cavernous malformation but with no relevant family history. Serial clinical and radiological follow-up revealed a progressive increase in the size of the lesion with formation of a growing cyst of 7 cm in diameter, which produced mass effect, resulting in the clinical picture of cerebral herniation. The patient underwent emergency surgical resection with symptomatic relief. There was no evidence of significant hemorrhage at surgery.

CONCLUSION

Cavernous malformations can show expansile growth without any evidence of a presaging hemorrhagic event and, in the manner of a neoplastic lesion, present with raised intracranial pressure and cerebral herniation.

Isolation of a cDNA encoding an IgG immunoreactive antigen (zinc finger protein) of Strongyloides stercoralis

A full length cDNA encoding an IgG immunoreactive antigen of Strongyloides stercoralis is described. A clone containing 1,328 bp insert was selected following screening of S. stercoralis cDNA library with an IgG fraction obtained from a pool of 78 S. stercoralis positive human sera samples. The nucleotide sequence of the 1,328 bp insert was found to be 70.5% A/T, reflecting a characteristic A/T codon bias of S. stercoralis. The nucleotide sequence of this insert identified a cDNA coding for a zinc finger protein. The conceptually translated amino acid sequence of the open reading frame for the IgG immunoreactive antigen of S. stercoralis encodes a 211 amino acid residue protein with an apparent molecular weight of 22.8 kDa and a predicted isoelectric point of 8.71. The diagnostic potential of this IgG immunoreactive antigen of S. stercoralis is also discussed.

The influence of HLA class I alleles and heterozygosity on the outcome of human T cell lymphotropic virus type I infection

The inflammatory disease human T cell lymphotropic virus type I (HTLV-I)-associated myelopathy (HAM/TSP) occurs in only 1-2% of HTLV-I-infected individuals and is associated with a high provirus load of HTLV-I. We hypothesize that a person's risk of developing HAM/TSP depends upon the efficiency of their immune response to the virus, which differs between individuals because of polymorphism in genes that influence this response. Previously we showed that the possession of HLA-A*02 was associated with a lower risk of HAM/TSP, and with a lower provirus load in healthy carriers of HTLV-I. However, HLA-A*02 did not account for all the observed difference in the risk of HAM/TSP. Here we present evidence, in the same study population in Japan, that HLA-Cw*08 was also associated with disease protection (probability value, two-tailed test = 0.002) and with a lower proviral load in healthy carriers. Possession of the A*02 and/or Cw*08 genes prevented 36% of potential HAM/TSP cases. In contrast, HLA-B*5401 was associated with a higher susceptibility to HAM/TSP (probability value, two-tailed test = 0.0003) and with a higher provirus load in HAM/TSP patients. At a given provirus load, B*5401 appeared to increase the risk of disease. The fraction of HAM/TSP cases attributable to B*5401 was 17%. Furthermore, individuals who were heterozygous at all three HLA class I loci have a lower HTLV-I provirus load than those who were homozygous at one or more loci. These results are consistent with the proposal that a strong class I-restricted CTL response to HTLV-I reduces the proviral load and hence the risk of disease.

Phenotypes of alpha 1 antitrypsin in Karachi, Pakistan

OBJECTIVE

To determine serum level of the protease inhibitor, to identify phenotypes and determine their frequencies.

STUDY DESIGN

A prospective study.

SETTING

PMRC, Research Centre, JPMC and the Aga Khan University Hospital, Karachi.

SUBJECTS

Healthy adults without history of peptic ulcer disease and a normal endoscopy.

METHODOLOGY

Quantitative measurement of serum alpha 1 AT was carried out by radial immunodiffusion, phenotyping by iso-electric focusing and confirmation of phenotypes by immuno-fixation and DNA analysis technique.

RESULTS

Serum alpha 1 AT was low in 13.4% of the subjects. MM phenotype predominated followed by SZ, SS,MZ and ZZ. DNA diagnosis accurately resolved the phenotypes as S and Z.

CONCLUSION

Frequency of phenotype associated with total and intermediate deficiency is less in the population.

Cloning and expression of isocitrate lyase from human round worm Strongyloides stercoralis

A full length cDNA (1463 bp) encoding isocitrate lyase (EC 4.1.3.1) of Strongyloides stercoralis is described. The nucleotide sequence of this insert identified a cDNA coding for the isocitrate lyase. The conceptually translated amino acid sequence of the open reading frame for S. stercoralis isocitrate lyase encodes a 450 amino acid residue protein with an apparent molecular weight of 50 kDa and a predicted pl of 6.39. The sequence is 69% A/T, reflecting a characteristic A/T codon bias of S. stercoralis. The amino acid sequence of S. stercoralis isocitrate lyase is compared with bifunctional glyoxylate cycle protein of Caenorhabditis elegans and isocitrate lyases from Chlamydomonas reinhardtii and Myxococcus xanthus. The full length cDNA of S. stercoralis was expressed in pRSET vector and bacteriophage T7 promoter based expression system. S. stercoralis lyase recombinant protein, purified via immobilized metal affinity chromatography, showed a molecular mass of 50 kDa on polyacrylamide gels. The role of isocitrate lyase in the glyoxylate cycle and energy metabolism of S. stercoralis is also discussed.

DDRT-PCR: use of agarose gels for detection of amplified products

The present study focuses on the detection of differentially expressed genes in migrating (healing) and nonmigrating (normal) corneal epithelium on agarose gel using a modified procedure of differential display reverse transcriptase-polymerase chain reaction (DDRT-PCR). Rabbit corneal epithelial organ cultures were used to obtain nonmigrating and migrating samples. RNA was extracted using Trizol LS reagent. PCR was modified in order to allow detection of amplified products on 3% agarose gel with ethidium bromide staining. Products were also resolved on 6% denaturing polyacrylamide-urea gels and observed by silver staining. Agarose gels showed two prominent bands that were heavily expressed in the 458 bp and 587 bp region of the nonmigrating samples. In addition light bands were visible in the region corresponding to 234 bp and 450 bp. In the migrating samples, two light bands were visible in the region of 267 bp and 300 bp. Eight amplicons, six in the nonmigrating corneal epithelial sample and two in the migrating corneal epithelial samples, were also found to be differentially expressed when products were run on 6% denaturing polyacrylamide-urea gels. Thus, DDRT-PCR products can be detected on agarose gels and prove very helpful and economical in the initial studies of DDRT-PCR.

A cDNA encoding the highly immunodominant antigen of Strongyloides stercoralis: gamma-subunit of isocitrate dehydrogenase (NAD+)

A full length cDNA encoding the highly immunodominant 41 kDa antigen of Strongyloides stercoralis (P5), recognized by 83% of human patients [Siddiqui et al. (1997) Parasitol Res 83:655-658], is obtained. A clone containing a 1371 bp insert was selected following screening of the S. stercoralis cDNA library with antibodies specific to antigen P5. The nucleotide sequence of this insert identified a cDNA coding for the gamma-subunit of isocitrate dehydrogenase (NAD+), GenBank Accession Number AF176568. The conceptually translated amino acid sequence of the open reading frame for the gamma-subunit of S. stercoralis isocitrate dehydrogenase (NAD+) encodes a 388 amino acid residue protein with an apparent molecular weight of 43 kDa and a predicted pI of 7.15. The sequence is 71% A/T, reflecting the characteristic A/T codon bias of S. stercoralis. The amino acid sequence of the S. stercoralis gamma-subunit of isocitrate dehydrogenase (NAD+) is compared with those of Caenorhabditis elegans, rat and human NAD(+)-ICDH. The diagnostic potential of the S. stercoralis gamma-subunit of isocitrate dehydrogenase (NAD+) is also discussed.

Priming of a beta-galactosidase (beta-GAL)-specific type 1 response in BALB/c mice infected with beta-GAL-transfected Leishmania major

To determine whether an ongoing response to Leishmania major would affect the response to a non-cross-reacting, non-leishmanial antigen, susceptible BALB/c mice and resistant C3H mice were infected with L. major parasites expressing Escherichia coli beta-galactosidase (beta-GAL); this parasite was designated L. major-betaGAL. BALB/c and C3H mice responded to infection with L. major-betaGAL by mounting a CD4 T-cell response to both parasite antigens and to the reporter antigen, beta-GAL. The phenotypes of these T cells were characterized after generating T-cell lines from infected mice. As expected, BALB/c mice responded to infection with L. major-betaGAL by producing interleukin 4 in response to the parasite and C3H mice produced gamma interferon (IFN-gamma) in response to the parasite and beta-GAL. Interestingly, however, BALB/c mice produced IFN-gamma in response to beta-GAL. Taken together, these results demonstrate that priming of IFN-gamma-producing cells can occur in BALB/c mice despite the fact the animals are simultaneously mounting a potent Th2 response to L. major.