44 Hipec Therapy-A New Development to Fight Cancer; Report Of 3 Cases

Introduction

HIPEC is highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. HIPEC delivers chemotherapy directly to cancer cells in abdomen. Cytoreductive surgery(CRS) combined with perioperative intraperitoneal chemotherapy is currently a valid treatment option for peritoneal dissemination of gastrointestinal, gynaecological cancers or primary peritoneal neoplasms.

Method

3 patients with peritoneal surface malignancy were selected. PET scan was done for all the patients to assess metastasis and peritoneal carcinomatosis index(PCI) calculated was<20 for all 3 patients They were then treated with CRS+HIPEC therapy with disease-specific chemotherapeutic agents like Cisplatin, Mitomycin and Doxorubicin and Oxaliplatin . Aim was

Results

All the 3 patients had a good post-operative recovery with no recurrence in the follow-up period

Conclusions

HIPEC and CRS plays synergistic role. A complete CRS followed by HIPEC with the disease-specific chemotherapeutic agent at 41-43ºC constitutes optimal treatment for certain malignancies. High regional concentration with low systemic concentration of chemotherapy, increased tissue penetration and thermal enhancement of cytotoxicity are some of the advantages with HIPEC therapy

Suicide and self-harm in women with mental disorders during pregnancy and the year after birth

Introduction

There is little prospective data on the risk factors for later suicide in women who experience perinatal mental disorders, particularly beyond one-year postnatal.

Objectives

Among a cohort of women who were in contact with a mental healthcare provider during the perinatal period, to: (1) Describe sociodemographic and clinical characteristics of the women who died by suicide (2) Understand when, in relation to childbirth, most suicides tended to occur.

Methods

Data-linkage of de-identified service-user electronic healthcare records, national hospital episode statistics and mortality data generated a cohort of women in contact with a mental healthcare service provider in London, UK, perinatally. Using Natural Language Processing and structured field extraction, we identified clinical, socio-demographic characteristics, self-harm exposure, and suicide.

Results

Among 5204 women, clinical and demographic characteristics of women who did and did not die by suicide were similar apart from indicators of illness severity including perinatal sedative medication prescription, clinician-rated functional impairment and smoking, which were more common in women who died by suicide. Suicide deaths occurred most frequently in the second year post-delivery. The most common method of suicide ocurring wihtin two years was by violent means, whereas after two years postnatal, the most common method was non-violent.

Conclusions

Our findings support the extension of perinatal mental healthcare service provision to two years post-delivery.

Disclosure

No significant relationships.

1147 Sleep Correlates With Improved Functional Outcome In The Intensive Care Unit

Introduction

Disruption of sleep may have significant implications in acute brain injury, functional recovery, and critical illness. Few data exist characterizing sleep architecture in patients admitted to an intensive care unit (ICU). We aim to describe sleep and clinical characteristics in patients with acute brain injury and critical illness.

Methods

Retrospective analysis was performed in ICU patients who underwent continuous electroencephalographic (EEG) monitoring from 2018-2019. Sleep was scored based on AASM-defined EEG criteria. Clinical variables, EEG characteristics, and modified Ranking Scale (mRS) were collected. Good outcome was defined as mRS<3. Differences were assessed using chi-square analysis and t-test.

Results

205 patients were reviewed with a mean age of 57 years (range 18-91) and a majority (57%) were male. Patients carried a primary neurologic/neurosurgical (61%) or medical/surgical (39%) diagnosis. Status epilepticus, subdural hemorrhage, traumatic brain injury, encephalopathy and cardiac arrest accounted for the majority of diagnoses encountered. Only 58 patients (28%) achieved N1 sleep; of these 76.4% achieved N2, 2.8% N3, and none achieved REM. Of those achieving any sleep, 43% had good outcomes versus only 23% in those who did not (t=-7.45, p<0.001). Neurological patients were more likely to attain sleep compared to those with other primary diagnoses (χ 2 (1)=7.08, p=0.008). Centrally acting anesthetics did not account for sleep differences between neurologic and non-neurologic patients (χ² (1)=2.01, p=0.16). However, those with primary brain injury reached sleep more often in the absence of anesthetic use (χ 2 (1)=4.82, p=0.03). The overall mortality was 32% in this cohort.

Conclusion

Most critically ill patients do not achieve electrophysiologic sleep. Of those who do, N1/N2 stages are seen most often. Neurological patients were more likely to sleep, and achieving any sleep was associated with improved functional outcome. Further studies are needed to determine whether sleep augmentation in the critically ill impacts functional outcome.

Support

N/A.

Cigarette smoke promotes HIV infection of primary bronchial epithelium and additively suppresses CFTR function

Recurrent lung infections are a common cause of morbidity and mortality in people living with HIV and this is exacerbated in smokers even when administered combination antiretroviral therapy (cART). The incidence of pneumonia is increased with smoking and treatment interruption and is directly dependent on viral load in patients when adjusted for CD4 counts. CFTR dysfunction plays an important role in aberrant airway innate immunity as it is pivotal in regulating mucociliary clearance (MCC) rates and other antibacterial mechanisms of the airway. In our earlier work, we have demonstrated that bronchial epithelium expresses canonical HIV receptors CD4, CCR5 and CXCR4 and can be infected with HIV. HIV Tat suppresses CFTR mRNA and function via TGF-β signaling. In the present study, we demonstrate that cigarette smoke (CS) potentiates HIV infection of bronchial epithelial cells by upregulating CD4 and CCR5 expression. HIV and CS individually and additively suppress CFTR biogenesis and function, possibly explaining the increased incidence of lung infections in HIV patients and its exacerbation in HIV smokers.

Genetic and other risk factors for suicidal ideation and the relationship with depression

BACKGROUND

There is a genetic contribution to the risk of suicide, but sparse prior research on the genetics of suicidal ideation.

METHODS

Active and passive suicidal ideation were assessed in a Sri Lankan population-based twin registry (n = 3906 twins) and a matched non-twin sample (n = 2016). Logistic regression models were used to examine associations with socio-demographic factors, environmental exposures and psychiatric symptoms. The heritability of suicidal ideation was assessed using structural equation modelling.

RESULTS

The lifetime prevalence of any suicidal ideation was 13.0% (11.7-14.3%) for men; 21.8% (20.3-23.2%) for women, with no significant difference between twins and non-twins. Factors that predicted suicidal ideation included female gender, termination of marital relationship, low education level, urban residence, losing a parent whilst young, low standard of living and stressful life events in the preceding 12 months. Suicidal ideation was strongly associated with depression, but also with abnormal fatigue and alcohol and tobacco use. The best fitting structural equation model indicated a substantial contribution from genetic factors (57%; CI 47-66) and from non-shared environmental factors (43%; CI 34-53) in both men and women. In women this genetic component was largely mediated through depression, but in men there was a significant heritable component to suicidal ideation that was independent of depression.

CONCLUSIONS

These are the first results to show a genetic contribution to suicidal ideation that is independent of depression outside of a high-income country. These phenomena may be generalizable, because previous research highlights similarities between the aetiology of mental disorders in Sri Lanka and higher-income countries.

Contributions of specific causes of death to lost life expectancy in severe mental illness

The life expectancy gap between people with severe mental illness (SMI) and the general population persists and may even be widening. This study aimed to estimate contributions of specific causes of death to the gap. Age of death and primary cause of death were used to estimate life expectancy at birth for people with SMI from a large mental healthcare case register during 2007-2012. Using data for England and Wales in 2010, death rates in the SMI cohort for each primary cause of death category were replaced with gender- and age-specific norms for that cause. Life expectancy in SMI was then re-calculated and, thus, the contribution of that specific cause of death estimated. Natural causes accounted for 79.2% of lost life-years in women with SMI and 78.6% in men. Deaths from circulatory disorders accounted for more life-years lost in women than men (22.0% versus 17.4%, respectively), as did deaths from cancer (8.1% versus 0%), but the contribution from respiratory disorders was lower in women than men (13.7% versus 16.5%). For women, cancer contributed more in those with non-affective than affective disorders, while suicide, respiratory and digestive disorders contributed more in those with affective disorders. In men, respiratory disorders contributed more in non-affective disorders. Other contributions were similar between gender and affective/non-affective groups. Loss of life expectancy in people with SMI is accounted for by a broad range of causes of death, varying by gender and diagnosis. Interventions focused on multiple rather than individual causes of death should be prioritised accordingly.

HIV Infects Bronchial Epithelium and Suppresses Components of the Mucociliary Clearance Apparatus

Recurrent lung infections and pneumonia are emerging as significant comorbidities in the HIV-infected population in the era of combination antiretroviral therapy (cART). HIV infection has been reported to suppress nasal mucociliary clearance (MCC). Since the primary components driving nasal MCC and bronchial MCC are identical, it is possible that bronchial MCC is affected as well. Effective MCC requires optimal ciliary beating which depends on the maintenance of the airway surface liquid (ASL), a function of cystic fibrosis transmembrane conductance regulator (CFTR) activity and the integrity of the signaling mechanism that regulates ciliary beating and fluid secretion. Impairment of either component of the MCC apparatus can compromise its efficacy and promote microbial colonization. We demonstrate that primary bronchial epithelium expresses HIV receptor CD4 and co-receptors CCR5 and CXCR4 and can be infected by both R5 and X4 tropic strains of HIV. We show that HIV Tat suppresses CFTR biogenesis and function in primary bronchial epithelial cells by a pathway involving TGF-β signaling. HIV infection also interferes with bronchial epithelial cell differentiation and suppresses ciliogenesis. These findings suggest that HIV infection suppresses tracheobronchial mucociliary clearance and this may predispose HIV-infected patients to recurrent lung infections, pneumonia and chronic bronchitis.

Antibiograms in resource limited settings: Are stratified antibiograms better?

Background Antibiograms often act as a reference guide for empirical selection of antibiotics. Hospital-wide antibiograms constructed on the basis of cumulative antimicrobial susceptibility data from diverse patient groups can often be misleading. In order to show the significance of age- and location-stratified antibiograms, this study compared hospital-wide antibiograms with stratified antibiograms for the clinical isolates of Pseudomonas aeruginosa. Methods Stratified antibiograms were created on the basis of patient age (<18 years, 18-50 years, >50 years) and location (inpatient or outpatient) using all 2011, 2012 and 2013 clinical isolates of P. aeruginosa isolates. Susceptibility rates were compared among cumulative and stratified antibiograms using non-parametric inferential statistics. Results The hospital-wide antibiogram under-estimated susceptibility rates in adult patients isolates (age group = 18-50 years) and over-estimated susceptibility rates in isolates from the paediatric patients and elderly. Paediatric isolates were found to be less susceptible to amikacin and imipenem, whereas isolates from elderly patients >50 years were less susceptible to ciprofloxacin. Statistically significant difference was seen in the susceptibility rates of OPD and IPD isolates of P. aeruginosa in the case of the paediatric age group. Susceptibility rates for all drugs were lower for isolates from inpatients than from outpatients. Conclusion Age and location associated differences in susceptibility rates have the potential to influence empirical antibiotic selection, which was shown in stratified antibiograms of P. aeruginosa that is obscured by hospital-wide antibiograms.

The prevalence of abnormal ECG in trained sportsmen

BACKGROUND

Competitive sports training causes structural and conductive system changes manifesting by various electrocardiographic alterations. We undertook this study to assess the prevalence of abnormal ECG in trained Indian athletes and correlate it with the nature of sports training, that is endurance or strength training.

METHODS

We evaluated a standard resting, lying 12 lead Electrocardiogram (ECG) in 66 actively training Indian athletes. Standard diagnostic criteria were used to define various morphological ECG abnormalities.

RESULTS

33/66 (50%) of the athletes were undertaking endurance training while the other 33 (50%) were involved in a strength-training regimen. Overall 54/66 (81%) sportsmen had significant ECG changes. 68% of these changes were considered as normal training related features, while the remaining 32% were considered abnormal. There were seven common training related ECG changes-Sinus Bradycardia (21%), Sinus Arrhythmia (16%), 1st degree Atrioventricular Heart Block (6%), Type 1 2nd-degree Atrioventicular Heart Block (3%), Incomplete Right bundle branch block (RBBB) (24%), Early Repolarization (42%), Left Ventricular Hypertrophy (LVH) (14%); while three abnormal ECG changes--T-wave inversion (13%), RBBB(4%), Right ventricular hypertrophy (RVH) with strain (29%) were noted. Early repolarization (commonest change), sinus bradycardia, and incomplete RBBB were the commoner features noticed, with a significantly higher presence in the endurance trained athletes.

CONCLUSION

A high proportion of athletes undergoing competitive level sports training are likely to have abnormal ECG recordings. Majority of these are benign, and related to the physiological adaptation to the extreme levels of exertion. These changes are commoner during endurance training (running) than strength training (weightlifting).

Using routine clinical and administrative data to produce a dataset of attendances at Emergency Departments following self-harm

Background

Self-harm is a significant public health concern in the UK. This is reflected in the recent addition to the English Public Health Outcomes Framework of rates of attendance at Emergency Departments (EDs) following self-harm. However there is currently no source of data to measure this outcome. Routinely available data for inpatient admissions following self-harm miss the majority of cases presenting to services.

We aimed to investigate (i) if a dataset of ED presentations could be produced using a combination of routinely collected clinical and administrative data and (ii) to validate this dataset against another one produced using methods similar to those used in previous studies.

Methods

Using the Clinical Record Interactive Search system, the electronic health records (EHRs) used in four EDs were linked to Hospital Episode Statistics to create a dataset of attendances following self-harm. This dataset was compared with an audit dataset of ED attendances created by manual searching of ED records. The proportion of total cases detected by each dataset was compared.

Results

There were 1932 attendances detected by the EHR dataset and 1906 by the audit. The EHR and audit datasets detected 77 % and 76 % of all attendances respectively and both detected 82 % of individual patients. There were no differences in terms of age, sex, ethnicity or marital status between those detected and those missed using the EHR method. Both datasets revealed more than double the number of self-harm incidents than could be identified from inpatient admission records.

Conclusions

It was possible to use routinely collected EHR data to create a dataset of attendances at EDs following self-harm. The dataset detected the same proportion of attendances and individuals as the audit dataset, proved more comprehensive than the use of inpatient admission records, and did not show a systematic bias in those cases it missed.

Isoflavone in Postmenopausal Women - Are They Really Effective? A Prospective Case Control Study

A prospective case control study was conducted at Medical College, Kolkata with the aim of evaluating the role of isoflavone( a class of phytoestrogen –plant compounds having the beneficial effects of estrogen but lesser risks and side effects) in postmenopausal women. 100 postmenopausal women (those who underwent total abdominal hysterectomy and bilateral salpingooopherectomy for different benign indications, aged between 40-50 years and who were menstruating before operation) were alternately distributed into two groups-Group A (n=50, received 60mg of isoflavone and 500mg of calcium per day for 6 months) and Group B (n=50, received 500mg of calcium per day only for 6 months). To evaluate the menopausal symptoms, the menopausal Kupperman index questionnaire was applied. Other outcomes measured were body mass index, blood pressure and lipid profile. Menopausal symptoms in Group A(those using isoflavones) were lower compared to Group B. The present study showed that Kupperman index decreased significantly in Group A (from 28.48 ± 2.03 to 16.32 ± 1.06 i.e. 45% decline) compared to Group B (from 24.56 ± 1.52 to 18.44 ± 1.11 i.e. 25% decline). No differences in blood pressure or body mass index were found during treatment between the two groups. . In our study total cholesterol, triglycerides and low-density lipoproteins (LDL) decreased significantly in Group A compared to Group B. Therefore our clinical study indicates that isoflavone can be an invaluable resource for postmenopausal women for combating menopausal symptoms. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 11-14 DOI: http://dx.doi.org/10.3126/njog.v7i1.8826

Unemployment, ethnicity and psychosis

OBJECTIVE

This study describes the incidence of psychosis in unemployed people and determines whether unemployment has a greater impact on the development of psychosis amongst Black minority groups than White groups.

METHOD

Patients with a first diagnosis of Research Diagnostic Criteria psychosis, in a defined area of London from 1998 to 2004, were identified. Crude and standardised incidence rates of psychosis amongst unemployed people for each ethnic group were calculated. Poisson regression modelling tested for interactions between unemployment and ethnicity.

RESULTS

Hundred cases occurred amongst employed people and 78 cases occurred amongst the unemployed people. When standardised to the employed White population of the area, White unemployed people had a standardised incidence ratio (SIR) of 11.7 (95% CI 6.4-19.7), Black Caribbean people had a SIR of 60.1(95% CI 39.3-88) and Black African people had a SIR of 40.7 (95% CI 25.8-61.1). There was no interaction however between ethnicity and unemployment (Likelihood ratio test P = 0.54).

CONCLUSION

Rates of psychosis are high amongst unemployed people in south London and extremely high amongst Black Caribbean and Black African unemployed people. There was no evidence however that the minority groups were particularly sensitive to the stresses, limitations or meaning of unemployment.

Mortality in first-contact psychosis patients in the U.K.: a cohort study

BACKGROUND

The excess mortality following first-contact psychosis is well recognized. However, the causes of death in a complete incidence cohort and mortality patterns over time compared with the general population are unknown.

METHOD

All 2723 patients who presented for the first time with psychosis in three defined catchment areas of the U.K. in London (1965-2004, n=2056), Nottingham (1997-1999, n=203) and Dumfries and Galloway (1979-1998, n=464) were traced after a mean of 11.5 years follow-up and death certificates were obtained. Data analysis was by indirect standardization.

RESULTS

The overall standardized mortality ratio (SMR) for first-contact psychosis was 184 [95% confidence interval (CI) 167-202]. Most deaths (84.2%, 374/444) were from natural causes, although suicide had the highest SMR (1165, 95% CI 873-1524). Diseases of the respiratory system and infectious diseases had the highest SMR of the natural causes of death (232, 95% CI 183-291). The risk of death from diseases of the circulatory system was also elevated compared with the general population (SMR 139, 95% CI 117-164) whereas there was no such difference for neoplasms (SMR 111, 95% CI 86-141). There was strong evidence that the mortality gap compared with the general population for all causes of death (p<0.001) and all natural causes (p=0.01) increased over the four decades of the study. There was weak evidence that cardiovascular deaths may be increasing relative to the general population (p=0.07).

CONCLUSIONS

People with first-contact psychosis have an overall mortality risk that is nearly double that of the general population. Most excess deaths are from natural causes. The widening of the mortality gap over the last four decades should be of concern to all clinicians involved in delivering healthcare.

Prevalence of extended spectrum beta lactamase (ESBL) production in gram negative isolates from pyogenic infection in tertiary care hospital of eastern Nepal

Emergence of extended spectrum beta lactamase (ESBL) producing isolates has important clinical and therapeutic implications. A high prevalence of ESBL production among multidrug resistant gram negative isolates has been reported in literature from various clinical samples. Since ESBL detection is not done on a routine basis, its prevalence is not known till date. Thus the present study was undertaken to determine the prevalence of ESBL production in gram negative isolates from pyogenic infection. A total of 300 gram negative bacilli isolated from the pus samples were identified phenotypically and antimicrobial activity was determined. ESBL detection among the isolated organisms was done by Phenotypic confirmatory disc diffusion technique recommended by CLSI. Of the 300 isolates, majority were Escherichia coli; (107) followed by Acinetobacter species; (55), Pseudomonas species; (44), Klebsiella pneumoniae; (32), Proteus mirabilis; (26), Enterobacter species; (25), Citrobacter species; (9) and others; (2). The prevalence of ESBL producing organisms was found to be 54 (18%); amongst which Escherichia coli was 29 (53.7%), Klebsiella pneumonia (14.8%), Proteus mirabilis 7 (12.9%) and others 4 (7.4%). Multidrug resistance were found in 92.6% of ESBL producers. Forty two were resistant to all the three third generation cephalosporins. The continuous surveillance of the ESBL producing isolates is necessary to make aware about the correct treatment regimens and good infection control practices.

294 PRODUCTION AND CHARACTERIZATION OF PUTATIVE NUCLEAR TRANSFER EMBRYONIC STEM CELLS DERIVED FROM HANDMADE CLONED EMBRYOS USING EMBRYONIC STEM CELLS, LYMPHOCYTES, AND ADULT FIBROBLAST CELLS AS DONOR CELLS IN GOAT

The handmade cloning technique has been a relatively recent addition in the field of nuclear transfer. In the present study, attempts were made to efficiently derive stem cells from handmade cloned (HMC) embryos in goat using adult fibroblast cells, embryonic stem (ES) cells, and lymphocytes as donor cells, and to characterise the derived putative nuclear transfer ES (ntES) cells for their stemness. Efficiency of the donor cells for nuclear transfer was also compared, and an overall cleavage and morula formation rates of 62.44 ± 3.9% and 35.30 ± 3.86%, 75.45 ± 3.92% and 45.84 ± 3.86%, and 56.38 ± 3.92% and 29.09 ± 3.86% were obtained from adult fibroblasts, ES cells, and lymphocytes, respectively. A significant difference was found between ES cells and the other 2 donor cells in terms of cleavage and morula formation. However, no such difference existed between fibroblasts and lymphocyte donor cells. Stem cell colonies were successfully derived from HMC embryos obtained from all 3 different donor cells. The rate of primary colony formation was 61.66 ± 4.62% for fibroblast-donor-cell-derived embryos. This rate was 59.91 ± 4.62% for ES-donor-cell-derived embryos and 62.49 ± 4.62% for lymphocyte-donor-cell-derived embryos. The putative ntES colonies were positively characterised for TRA-1-60, TRA-1-81, SSEA-1, SSEA-4, OCT-4, SOX-2, and Nanog by immunocytochemistry and RT-PCR. Results indicated that ES cells had better efficiency as donor cells in cloned embryo production than did adult fibroblasts and lymphocytes. The finding also suggested that terminally differentiated cell-like lymphocytes can also be reprogrammed. Moreover, there was no difference between the different donor-cell-derived HMC embryos in terms of ntES cell derivation. The study has established an efficient protocol for putative ntES cell derivation from HMC embryos. This could be of substantial significance because patient-specific ntES cells have proven therapeutic significance. The authors acknowledge N.D.R.I for the financial and infrastructural assistance.

304 RHYTHMIC BEATING OF HEART MUSCLE GENERATED FROM GOAT EMBRYONIC STEM CELLS

The aim of the present study was to isolate, culture, and characterise goat embryonic stem cell (ESC)-like cells from in vitro fertilized goat embryos. Oocytes were collected from slaughterhouse goat ovaries, and IVF was performed with standard protocol. A total of 60.48% cleavage, 24.01% morulae, 11.35% blastocyst, and 3.4% hatched blastocyst were obtained. Goat ESC-like cells were isolated from individual blastomere cells of early embryos after 2 mg mL–1 of pronase treatment and inner cell mass (ICM) of blastocyst. The ICM were isolated mechanically from 80 expanded blastocysts and 20 hatched blastocysts and enzymatically from 45 expanded blastocysts and 20 hatched blastocysts. The primary colony formation was obtained mechanically from expanded blastocysts (66%) and hatched blastocysts (90%) and enzymatically from expanded blastocysts (30%) and hatched blastocysts (73%). The ICM were cultured on 10 μg mL–1 of mitomycin-C inactivated fetal fibroblast feeder layer and with leukemia inhibitory factor (LIF) without feeder layer. Embryonic stem cells were cultured and characterised by immunofluorescence of surface markers such as alkaline phosphatase, Oct-4, SSEA-1, SSEA-3, SSEA-4 and intracellular molecular markers Oct-4, Sox2, Nanog. The primary colony formation was significantly higher when hatched blastocysts (90%) were used for ICM than when expanded blastocysts (66%), morulae (15%), and single blastomere (10%) were used. Five goat ESC lines were produced, which were maintained undifferentiated on a feeder layer in ESC medium containing LIF up to 5th, 7th, 10th, 20th, and 22nd passages. Three goat ESC lines were also produced in ESC medium containing LIF without feeder layer and maintained undifferentiated up to 5th, 10th, and 12th passages. All the cell lines expressed alkaline phophatase and OCT-4, at 5th, 10th, 15th, and 20th passages. The ESC of passage 20 were used for embryoid body formation for 3 days. The embryoid bodies were cultured to induce differentiation in medium contain activin-A, fibroblast growth factor-2, and BMP-4. The embryoid bodies were analysed with molecular markers such as Gata, BMP4, and Nestin and were found positive. The cardiac tissues were also observed to be positive with cardiac-specific molecular markers such as α actinin, troponin, and α-myosin heavy chain and its histology. The rhythmic beating was found after 30 days of culture, and the beating was still continuing after 42 days. These goat ESC were cryopreserved into LN2 for a long period of time for further use in the future. It could be concluded that goat ESC were maintained undifferentiated up to 22nd passage with feeder layer and 12th passages without feeder layer using LIF only. Cardiomyocyte rhythmic beating of heart muscle was generated from goat ESC. To the best of our knowledge, this is the first time beating has been observed in goat ESC cardiomyocytes in the world. The authors have not found any report on animals such as cattle, buffalo, sheep, and pig, except mouse, monkey, and human being.

305 CONSTRUCTION OF TRANSCRIPTION FACTOR GENES FOR REPROGRAMMING OF ADULT GOAT FIBROBLAST CELLS FOR PRODUCTION OF INDUCED PLURIPOTENT STEM CELLS

Embryonic stem cells (ESC) are derived from the inner cell mass of blastocysts and proliferate extensively while maintaining pluripotency. They can be used for the treatment of juvenile diabetes, Parkinson’s disease, heart failure, and spinal cord injury. However, the use of embryos and tissue rejection remain concerns for ESC transplantation. Reprogramming of somatic cells may be done by different methods such as somatic cell nuclear transfer (Wilmut et al. 1997), fusion of somatic cells (Cowen et al. 2005), treatment with the extract of the pluripotent stem cells (Johnson Rajasingh 2008), and by the stable ectopic expression of defined factors in the somatic cells (Takahashi and Yamanaka 2006). Several transcription factors, including Oct3/4 (Nichols et al. 1998; Niwa et al. 2000), Sox2 (Avilion et al. 2003), and Nanog (Chambers et al. 2003; Mitsui et al. 2003), function in the maintenance of pluripotency in both early embryos and ESC. Takahashi and Yamanaka reported reprogramming the fibroblast cells into stem cells by introducing Oct3/4, Sox2, c-Myc, and Klf4 in mouse embryonic and adult fibroblasts. Yu et al. (2007) demonstrated that four transcription factors (OCT-4, SOX2, NANOG, and LIN28) are sufficient to reprogramme human somatic cells to pluripotent stem cells that exhibit the essential characteristics of ESC. Nakagawa et al. (2008) used three factors (OCT3/4, SOX2, and KLF4) for human iPS cell production from somatic cells. We are trying to reprogramme the adult goat fibroblast cells in induced pluripotent stem cells by using ectopic expression of transcription factors such as Oct-4, Sox2, Nanog, and Lin28. We collected the ovaries from a slaughtered animal from Delhi and collected the oocytes from ovaries. Then after the collection, A and B grade oocytes were selected. Selected oocytes were processed and incubated in in vitro maturation media for 24 h. We collected semen from a male goat, and it was processed and capacitated in sperm TALP. Capacitated sperms were used for IVF of the in vitro matured oocytes in ferTALP. After 12 h sperm were washed from oocytes in embryo developing media (EDM), and oocytes were cultured (in vitro) in EDM. After 24 h cleavage occurred. The cleaved embryos were cultured for 6 to 7 days. At the 7th day, we got blastocysts. From these blastocysts, inner cell mass was isolated enzymatically and cultured to get ESC. The ESC were cultured for 7 passages and used for RNA isolation. The RNA was isolated from these stem cells by the Trizol method. Complementary DNA was prepared by RT-PCR. Using gene-specific primer for Oct-4, Nanog, and Sox2, DNA was amplified. The DNA for the Oct-4, Nanog, and Sox2 genes was cloned in pJET cloning vector and transformed in Top10 E. coli competence cells. After screening, plasmid was isolated and sent for sequencing. Sequences were analysed and the complete open reading frame was created for Oct-4, Nanog, and Sox2.

Left ectopic kidney with non rotation: a case report

Congenital anomalies of the urinary tract system are common. The ectopic pelvic kidney is a rare anomaly about 1:2500 live births, left side being more common. Here we are reporting a case of left ectopic kidney with non rotation and morphologically normal right kidney. The case was found during routine dissection in the department of anatomy in an adult male cadaver. There were no other anomalies observed.

Protective or pathogenic immune response to genital chlamydial infection in women--a possible role of cytokine secretion profile of cervical mucosal cells

Little is known about genital mucosal immune response to chlamydial infection in women with or without sequelae (Chlamydia positive women with or without fertility disorders as infertility and multiple spontaneous abortions). Cervical lymphocytes were stimulated with chlamydial EBs and cytokine secretion was determined by ELISA, RT-PCR and ELISPOT assays. Stimulated cervical cells from women with fertility disorders (FD) secrete significantly (P<0.05) higher levels of IL-1beta, IL-6, IL-8 and IL-10 and cells from fertile women secrete significantly higher levels of IL-12 and IFN-gamma compared to other groups. RT-PCR analysis showed similar results for IFN-gamma and IL-12. For IL-10 and IL-4, mRNA expression levels were significantly higher (P<0.05) in cells obtained from women with FD compared to other groups. Results for ELISPOT assay were similar as those of RT-PCR. The results suggest that cytokine secretion profile of cervical cells may decide whether infection does not hamper fertility or will develop fertility disorder.

Seroprevalence of antibodies to conserved regions of Chlamydia trachomatis heat shock proteins 60 and 10 in women in India

Persistent, untreated chlamydial infection causes chronic stimulation of the host immune system against immunogenic antigens such as chlamydial heat shock proteins (cHSP) 60 and 10. In order to find the seroprevalence of antibodies to cHSPs, enzyme-linked immunosorbent assay (ELISA) is performed using specific peptide sequences to measure antibody response against major outer membrane protein (MOMP), cHSP60 and cHSP10 in patient sera. In this study, 255 patients attending the gynaecology out-patient department (March 2004 to August 2005) of Safdarjung Hospital were enrolled. Of these patients, 107 were diagnosed with cervicitis while 52 had pelvic inflammatory disease (PID)/infertility. Chlamydia trachomatis infection in endocervical specimens is diagnosed by a direct fluorescence assay (DFA) and the polymerase chain reaction (PCR). In 75 (29.4%) of the C. trachomatis-positive women, 50 (66.7%) were ELISA positive for MOMP 48 (64.0%) were positive for cHSP60 and 46 (61.3%) were positive for cHSP10. The anti-MOMP index correlated positively with anti-cHSP60 (R = 0.522, P < 0.01) and anti-cHSP10 (R = 0.286, P < 0.05). Antibody titre for MOMP was significantly higher than that for cHSP60 (1:5; P < 0.01 and 1:25; P < 0.05). Moreover, patients with PID/infertility showed significantly higher antibody titres for cHSP60 and cHSP10 when compared to patients with cervicitis at dilutions of 1 in 50, 1 in 250, 1 in 1250 (P < 0.001) and at 1 in 6250 (P < 0.01).

A comparison of symptoms and family history in schizophrenia with and without prior cannabis use: implications for the concept of cannabis psychosis

BACKGROUND

There is considerable interest in cannabis use in psychosis. It has been suggested that the chronic psychosis associated with cannabis use, is symptomatically distinct from idiopathic schizophrenia. Several studies have reported differences in psychopathology and family history in people with schizophrenia according to whether or not they were cannabis users. We set out to test the hypotheses arising from these studies that cannabis use is associated with more bizarre behaviour, more thought disorder, fewer negative symptoms including blunted affect, more delusions of reference, more paranoid delusions and a stronger family history of schizophrenia.

METHOD

We used a case register that contained 757 cases of first onset schizophrenia, 182 (24%) of whom had used cannabis in the year prior to first presentation, 552 (73%) had not and 3% had missing data. We completed the OPCRIT checklist on all patients and investigated differences in the proportion of people with distractibility, bizarre behaviour, positive formal thought disorder, delusions of reference, well organised delusions, any first rank symptom, persecutory delusions, abusive/accusatory hallucinations, blunted affect, negative thought disorder, any negative symptoms (catatonia, blunted affect, negative thought disorder, or deterioration), lack of insight, suicidal ideation and a positive family history of schizophrenia, using chi square tests. Logistic regression modelling was then used to determine whether prior cannabis use affected the presence of the characteristics after controlling for age, sex and ethnicity.

RESULTS

There was no statistically significant effect of cannabis use on the presence of any of the above. There remained however a non-significant trend towards more insight (OR 0.65 p=0.055 for "loss of insight") and a finding of fewer abusive or accusatory hallucinations (OR 0.65 p=0.049) of borderline significance amongst the cannabis users. These were in the hypothesised direction. There was no evidence of fewer negative symptoms or greater family history amongst cannabis users.

CONCLUSION

We found few appreciable differences in symptomatology between schizophrenic patients who were or were not cannabis users. There were no differences in the proportion of people with a positive family history of schizophrenia between cannabis users and non-users. This argues against a distinct schizophrenia-like psychosis caused by cannabis.

Inflammatory markers in meconium induced lung injury in neonates and effect of steroids on their levels: A randomized controlled trial

PURPOSE

To determine the levels of TNFa and IL-1beta in tracheal aspirates of neonates with meconium aspiration syndrome (MAS) and to ascertain whether the use of steroids by systemic or nebulized routes suppresses the levels of these inflammatory markers.

METHODS

This was a double blind, randomized, controlled, prospective, interventional study done over one year period in the neonatal unit of the Lady Hardinge Medical College. Fifty-one babies of MAS which were randomly distributed into three groups; control, systemic and nebulized steroids; were included in the study. Methyl prednisolone was given intravenously in the dosage of 0.5 mg/kg/day in two divided doses while nebulized budecort was given in a dosage of 50 mcg/dose twice daily. Tracheal aspirates were taken on day 1, 3 and 4 and were analyzed for TNFa and IL-1b by ELISA technique.

RESULTS

TNFa in tracheal aspirates showed an increasing trend in babies of MAS in first four days, thereby signifying an inflammatory process underlying the condition. The levels of TNFa were suppressed by use of steroids. Higher levels of TNFa were associated with longer stay in hospital. IL-1b did not show any significant correlation.

CONCLUSIONS

TNFa is associated with meconium-associated inflammation. Its level is suppressed with the use of steroids and can also be used to assess prognosis of neonates with MAS.

Prevalence of Chlamydia trachomatis and bacterial vaginosis in women presenting to the early pregnancy unit

A total of 674 women attending the early pregnancy unit during the study period were offered screening with high vaginal and endocervical swabs and 516 agreed to participate in the study. The overall prevalence of chlamydia was 1.96% (95% CI 0.9-3.6). Some 10.5% were under the age of 25 years and the prevalence in this group was 1.85% (95% CI 0.05-9.9). The overall prevalence of bacterial vaginosis was 3.5% (95% CI 2.2-5.5). The prevalence of common genital infections is low in a population of women presenting to the early pregnancy unit. This is of relevance to women having surgical evacuation for miscarriage and randomised trials should be undertaken to evaluate the role of prophylactic antibiotics for such cases.

Clinical evaluation of the electronic nose in the diagnosis of ear, nose and throat infection: a preliminary study

The term electronic nose describes an electronic system that is able to mimic the human sense of smell. Electronic noses have been developed over the last 10 or more years to perform a variety of identification tasks in various industries. More recently electronic noses have attracted new interest in their application in the field of medical diagnosis. The aim of this study is to explore the use of an electronic nose to identify and classify pathogens associated with ear, nose and throat (ENT) infections. In this study 90 bacterial swab samples were collected from 90 patients with ENT infections. Some of these samples were analysed immediately with a commercial electronic nose (Cyranose C320). Similar numbers of swabs were also taken from the same site of infection and were sent for microbiology culture and sensitivity. The electronic nose diagnosis was compared with the microbiology diagnosis and it was found that the electronic nose diagnosis was correct in 88.2 per cent of the cases, which is an encouraging result.

Genetic structure and affinity among eight ethnic populations of Eastern India: based on 22 polymorphic DNA loci

The nature and extent of genetic variation at 22 polymorphic DNA loci, belonging to three distinct classes, especially, 12 STR loci (D3S1358, vWA, FGA, D5S818, D13S317, D7S820, D8S1179, D21S11, D18S51, HPRTB, F13B, LPL), four VNTR loci (D1S7, D4S139, D5S110, D17S79), and six coding loci (HLDQA1, LDLR, GYPA, HBGG, D7S8, GC) were investigated among eight population groups of West Bengal and Manipur regions of India. Of these, two groups from West Bengal belong to Caucasoid and six (one in WB and five in Manipur) belong to Mongoloid stock. Both STR and the expressed loci show wide diversity among the eight populations. For example, Manipur Muslims show differences in allele frequency when compared to four other regional populations. Similarly, Garo, one of the Mongoloid populations of West Bengal, differ in allele frequency from their counterparts in the Manipur region. Departure from Hardy-Weinberg expectations was observed at certain loci in a few populations (e.g., D21S1137 in Kayastha and Brahmin, HUM F13B in Meitei). Heterozygosity values were higher for Caucasoid than Mongoloid groups. The overall gene differentiation (GST) for STR loci is higher (5.3%) than for those at the expressed region (4.6%). The clustering pattern of the eight populations differs with respect to different classes of genetic markers used. The dendrograms based on six coding loci (HLDQA1, LDLR, GYPA, HBGG, D7S8, GC) differs from those based on STR and VNTR markers. Caucasoid and Mongoloid groups form different clusters and Manipur Muslims are distinct from others. The clustering pattern corresponded with the spatial and ethnic affiliations of the populations. Using different classes of DNA loci at the coding and noncoding region will help to better understand the influence of population structure variables on the genetic structure of populations.

Detection of species of graft in xenotransplants using arbitrary primed polymerase chain reaction

Because of a shortage in the availability of human organs, xenografts have been attempted in humans with cardiac, renal, and hepatic failure, despite limited success. Use of xenografts, however, is regulated under law in various countries. In xenotransplant cases related to violation of transplantation law, determination of species of the source of tissue and organ(s) becomes highly essential. Random amplified polymorphic DNA (RAPD) protocols using six sets of arbitrary short-sequenced primers have been standardized for verifying claims of porcine cardiac and renal grafts in human transplantation cases. Six arbitrary primers used were found to generate unique amplicon patterns at 36 degrees C annealing temperature. Among the selected primers, a single primer set having the sequence 5'- GGTGCGGGAA -3' is found to be the most informative in discerning porcine tissue contamination in humans. The patterns obtained were consistent for a particular genome. The grafted organs in the studied case were analyzed to be of porcine origin.