Inflammation across tissues: can shared cell biology help design smarter trials?

Immune-mediated inflammatory diseases (IMIDs) are responsible for substantial global disease burden and associated health-care costs. Traditional models of research and service delivery silo their management within organ-based medical disciplines. Very often patients with disease in one organ have comorbid involvement in another, suggesting shared pathogenic pathways. Moreover, different IMIDs are often treated with the same drugs (including glucocorticoids, immunoregulators and biologics). Unlocking the cellular basis of these diseases remains a major challenge, leading us to ask why, if these diseases have so much in common, they are not investigated in a common manner. A tissue-based, cellular understanding of inflammation might pave the way for cross-disease, cross-discipline basket trials (testing one drug across two or more diseases) to reduce the risk of failure of early-phase drug development in IMIDs. This new approach will enable rapid assessment of the efficacy of new therapeutic agents in cross-disease translational research in humans.

A comparative study of microwave oven-assisted tissue processing and conventional method of tissue processing on turnaround laboratory time and morphological quality of tissue sections

INTRODUCTION

The purpose of tissue processing is to fix the tissue in a solid medium toenable thin sections. Conventional method of tissue processing is the standardized method of tissue processing which has been used for more than 10 decades. However, the conventional method is time-consuming, and the overall turnaround time for the histopathology report is at least two days. The objective of this study is to identify the protocol for tissue processing procedure using domestic microwave oven. To determine the tissue processing time when using domestic microwave oven. To compare the morphological quality of tissue slides made by domestic microwave oven and conventional method using automated tissue processor.

MATRIALS AND METHODS

The conventional protocol and three microwave protocols of tissue processing were used in this study. A pilot study was done prior to the real run to determine the baseline timing for microwave protocol. The baseline timing was fixed at 2 minutes,30 minutes,5 minutes and 25 minutes. The processing time of the microwave protocol was adjusted from 62 minutes to 70 minutes to 77 minutes by increasing the dehydration and wax impregnation time while the time for tissue fixation and clearing remain the same throughout all the microwave protocols.

RESULTS

The group 2 microwave protocol produced the sections that is closely comparable to group 1 conventional protocol. The morphological quality of histopathology slides is best observed when the processing time of microwave protocol is 62 minutes.

CONCLUSION

The most appropriate microwave protocol for tissue processing is group 2 as the morphological quality of histopathology slides are more superior than that of group 1 with an overall percentage of 80% of satisfactory slides in group 2 and 76.68% in group 1.

Acute pulmonary embolism: in hospital outcome from a prospective observational registry (M-PER) from a low-and middle-income country

Background

Acute Pulmonary embolism the third most common cause of cardiovascular death in the world. Despite the large burden of acute pulmonary embolism, there is a paucity of prospective data from low-and middle-income countries.

Purpose

To study the clinical characteristics, treatment strategies employed, in-hospital outcome, one-year follow up results, and the prognostic factors in patients with acute pulmonary embolism from a low-and middle-income country.

Methods

All consecutive patients diagnosed with and treated for acute pulmonary embolism at our institution from November 2016 to November 2021 were included in the registry. Pulmonary embolism was diagnosed using clinical features (Wells' criteria of ≥3) supported by either CT angiogram or echocardiogram. Detailed history, clinical examination, preliminary basic blood investigations, cardiac troponins along with coagulation workup, ECG and ECHO were done for all patients. Patients were classified as having massive or high risk, submassive or intermediate risk and low risk pulmonary embolism based hemodynamic status, sPESI score, echocardiogram and cardiac troponins. Treatment was at the discretion of treating physician. In general, all patients with massive pulmonary embolism were considered for thrombolysis. All patients received anticoagulation with unfractionated heparin. Outcomes included hospital lengths of stay, all-cause in-hospital mortality and one year mortality

Results

186 patients with acute pulmonary embolism were prospectively enrolled during period. 62% were male. Mean age was 42.38±13.4 years. The risk factors noticed include prior history of venous thromboembolism, active malignancy, recent surgery, trauma, immobilisation, diabetes, hypertension, and chronic obstructive pulmonary disease in 18%, 5%, 10%, 8%, 14%, 17%, 10% and 3% of our patients respectively. Shortness of breath (98%), chest pain (37%), leg swelling (37%), cough (33%), shock (27%), syncope (15%) and haemoptysis (12%) were the reasons for presentation. Sinus tachycardia was the commonest finding (80%).

Right ventricular (RV) strain pattern was present in 68%, S1Q3T3 pattern in 56% and RBBB in 32%. RV dilatation was present in 93% and RV dysfunction in 75%. Thrombus was visualised in the pulmonary artery in 37% and right heart chambers in 12% (714). 26% were classified as high risk, 60% as intermediate risk and 13.4% as low risk acute pulmonary embolism. Overall 50% (92% of high-risk and 41% of intermediate risk) patients received fibrinolytic therapy.

In hospital mortality was 16% (29 patients) of which 72% were from high-risk group. In the high-risk group those who were fibrinolysed had a lower mortality compared to those not lysed. (75% vs 40%). This difference was not observed in the intermediate risk group.

Conclusion

Acute pulmonary embolism is a disease with high in-hospital mortality. Fibrinolytic therapy with streptokinase has a lifesaving potential in high risk patients.

Funding Acknowledgement

Type of funding sources: None.

Cross-tissue, single-cell stromal atlas identifies shared pathological fibroblast phenotypes in four chronic inflammatory diseases

BACKGROUND

Pro-inflammatory fibroblasts are critical for pathogenesis in rheumatoid arthritis, inflammatory bowel disease, interstitial lung disease, and Sjögren's syndrome and represent a novel therapeutic target for chronic inflammatory disease. However, the heterogeneity of fibroblast phenotypes, exacerbated by the lack of a common cross-tissue taxonomy, has limited our understanding of which pathways are shared by multiple diseases.

METHODS

We profiled fibroblasts derived from inflamed and non-inflamed synovium, intestine, lungs, and salivary glands from affected individuals with single-cell RNA sequencing. We integrated all fibroblasts into a multi-tissue atlas to characterize shared and tissue-specific phenotypes.

FINDINGS

Two shared clusters, CXCL10+CCL19+ immune-interacting and SPARC+COL3A1+ vascular-interacting fibroblasts, were expanded in all inflamed tissues and mapped to dermal analogs in a public atopic dermatitis atlas. We confirmed these human pro-inflammatory fibroblasts in animal models of lung, joint, and intestinal inflammation.

CONCLUSIONS

This work represents a thorough investigation into fibroblasts across organ systems, individual donors, and disease states that reveals shared pathogenic activation states across four chronic inflammatory diseases.

FUNDING

Grant from F. Hoffmann-La Roche (Roche) AG.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

IL-1-driven stromal-neutrophil interactions define a subset of patients with inflammatory bowel disease that does not respond to therapies

Current inflammatory bowel disease (IBD) therapies are ineffective in a high proportion of patients. Combining bulk and single-cell transcriptomics, quantitative histopathology and in situ localization across three cohorts of patients with IBD (total n = 376), we identify coexpressed gene modules within the heterogeneous tissular inflammatory response in IBD that map to distinct histopathological and cellular features (pathotypes). One of these pathotypes is defined by high neutrophil infiltration, activation of fibroblasts and vascular remodeling at sites of deep ulceration. Activated fibroblasts in the ulcer bed display neutrophil-chemoattractant properties that are IL-1R, but not TNF, dependent. Pathotype-associated neutrophil and fibroblast signatures are increased in nonresponders to several therapies across four independent cohorts (total n = 343). The identification of distinct, localized, tissular pathotypes will aid precision targeting of current therapeutics and provides a biological rationale for IL-1 signaling blockade in ulcerating disease.

Outcome of subsequent pregnancy after peripartum cardiomyopathy from a low middle income country- a prospective single center study

Background

Heart failure is the most common complication of women wiht heart disease going through pregnancy. Peripartum cardiomyopathy (PPCMP) is the most common cause of heart failure in pregnancy. PPCMP presents towards the end of pregnancy or in the early months following delivery and has devastating medical, mental and socio-cultural consequences. PPCMP patients may land up with a subsequent pregnancy (SSP) due to cultural and social pressures. Early detection and management with multi-disciplinary approach is crucial.

Purpose

Analysis of clinical course, maternal and fetal outcomes in women with SSP after PPCMP in the index pregnancy (IP).

Methods

Women diagnosed with PPCMP between 2016 to 2019 in a tertiary referral centre in a low and middle income country, who had at least one SSP were included in this prospective analysis. Patients were followed up throughout the pregnancy and for two years after the SSP. Clinical presentation, medication use, echocardiographic data, breast feeding, contraception use, counselling given, maternal and fetal outcome of pregnancy were analyzed.

Results

Fifty-two patients were diagnosed to have PPCMP in our institution from 2016 to 2019. Seven patients had eight singleton SSPS. The mean age of these patients was 25.8±4.2 years.

Index pregnancy details: Five patients had required inotropic support during the IP with two of them requiring ventilatory support. Other two had mild heart failure. Eight index pregnancies resulted in five live births, one neonatal birth, one still birth and one medical termination of pregnancy (MTP). All five women with live births breast fed their children after the IP. Contraception by IUCD was used in four patients. Two women did not accept any means of contraception. All patients had underwent appropriate multidisciplinary counselling about risks of SSP. All except one patient had recovered LV function with LVEF ≥55% within one year of IP. Three patients had stopped anti failure therapy on their own before SSP. The mean duration of anti-failure therapy was 13±5 months.

Subsequent pregnancy details: (Fig. 1) One patient with non-recovered LV function developed HF during the SSP and underwent MTP at 20 weeks. She continues to have LV dysfunction and NYHA III heart failure. Six patients who had recovered LV function, did not suffer any recurrence, one of whom is still in the 34th week of gestation. One of these patients had two SSPs. The first SSP was uneventful without recurrence. She is in the 34th week of her second SSP and is uneventful so far.

Neonatal outcome of the SSPs was good with five live births and one MTP in the 6 completed SSPs.

Conclusion

Baseline LVEF after IP is an important predictor of maternal & fetal outcome outcome. With detailed cardiac evaluation including stress echocardiogram, multidisciplinary counseling and close supervision patients with previous PPCMP patient can be allowed for an SSP with reasonable safety.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Flowchart of SSP outcome in PPCMP

South Indian zebu dwarf cattle show higher natural resistance to tick infestation compared to crossbreds: preliminary observations

The present study aimed to evaluate the influence of various factors on the host resistance of cattle against tick infestation in Kerala State, South India. The number of naturally infested semi-engorged female ticks present on the cattle was counted on a sample cattle population across the four regions of Kerala. Then, the animals were grouped based on the tick count. The chi-square test and Fisher exact test were used to identify the effects of genetic and non-genetic factors on tick burden in cattle. It was found that the Holstein Friesian crossbred and Jersey crossbred cattle had a significantly higher level of tick infestation than the indigenous Vechur breed (Bos indicus). No tick infestation was observed in indigenous Kasaragod Dwarf cattle (B. indicus). Tick infestation was more in heifers and dry animals than lactating animals. However, the sex of the animal and the stage of lactation did not influence the tick load. Tick infestation was also influenced by parity, grazing, and region.

Instillation of bradykinin into femoral artery elicits cardiorespiratory reflexes involving perivascular afferents in anesthetized rats

The physiology of baroreceptors and chemoreceptors present in large blood vessels of the heart is well known in the regulation of cardiorespiratory functions. Since large blood vessels and peripheral blood vessels are of the same mesodermal origin, therefore, involvement of the latter in the regulation of cardiorespiratory system is expected. The role of perivascular nerves in mediating cardiorespiratory alterations produced after intra-arterial injection of a nociceptive agent (bradykinin) was examined in urethane-anesthetized male rats. Respiratory frequency, blood pressure, and heart rate were recorded for 30 min after the retrograde injection of bradykinin/saline into the femoral artery. In addition, paw edema was determined and water content was expressed as percentage of wet weight. Injection of bradykinin produced immediate tachypneic, hypotensive and bradycardiac responses of shorter latency (5-8 s) favoring the neural mechanisms involved in it. Injection of equi-volume of saline did not produce any responses and served as time-matched control. Paw edema was observed in the ipsilateral hind limb. Pretreatment with diclofenac sodium significantly attenuated the bradykinin-induced responses and also blocked the paw edema. Ipsilateral femoral and sciatic nerve sectioning attenuated bradykinin-induced responses significantly, indicating the origin of responses from the local vascular bed. Administration of bradykinin in the segment of an artery produced reflex cardiorespiratory changes by stimulating the perivascular nociceptors involving prostaglandins. This is a novel study exhibiting the role of peripheral blood vessels in the regulation of the cardiorespiratory system.

Significant cardiac disease complicating Graves' disease in previously healthy young adults

SUMMARY

Graves' disease is associated with tachydysrythmia, cardiac ischaemia and cardiomyopathy - all uncommon in young adults without previous cardiac disease. We present three young individuals who developed cardiac complications after periods of uncontrolled Graves' disease. Subject 1: A 34-year-old female had severe thyrotoxic symptoms for weeks. Investigations showed fT4: 98.4 (11-25 pmol/L), fT3: 46.9 (3.1-6.8 pmol/L), TSH <0.01 (0.27-4.2 mU/L) and thyrotrophin receptor antibody (TRAb): 34.8 (<0.9 U//l). She had appropriate treatment but several weeks later she became breathless despite improving thyroid function. Echocardiography showed a pericardial effusion of 2.9 cm. She responded well to steroids and NSAIDs but developed active severe Graves' orbitopathy after early total thyroidectomy. Subject 2: A 28-year-old male developed thyrotoxic symptoms (fT4: 38 pmol/L, fT3: 13.9 pmol/L, TSH <0.01 (for over 6 months) and TRAb: 9.3 U/L). One month after starting carbimazole, he developed acute heart failure (HF) due to severe dilated cardiomyopathy - EF 10-15%. He partially recovered after treatment - EF 28% and had early radioiodine treatment. Subject 3: A 42-year-old woman who had been thyrotoxic for several months (fT4: 54.3; fT3 >46.1; TSH <0.01; TRAb: 4.5) developed atrial fibrillation (AF) and heart failure. Echocardiography showed cardiomegaly - EF 29%. She maintains sinus rhythm following early total thyroidectomy (EF 50%). Significant cardiac complications may occur in previously fit young adults, who have had uncontrolled Graves' disease for weeks to months. Cardiac function recovers in the majority, but early definitive treatment should be discussed to avoid Graves' disease relapse and further cardiac decompensation.

LEARNING POINTS

Cardiac complications of Graves' disease are uncommon in young adults without previous cardiac disease. These complications may however occur if Graves' disease had been poorly controlled for several weeks or months prior to presentation. Persistent symptoms after adequate control should alert clinicians to the possibility of cardiac disease. Specific treatment of Graves' disease and appropriate cardiac intervention results in complete recovery in the majority and carries a good prognosis. Early definitive treatment should be offered to them to prevent cardiac decompensation at times of further relapse.

Effect of Oxygen Vacancy on Structural, Optical and Magnetic Behavior of Tin Oxide Nanoparticles

Nanocrystalline SnO2powder has been successfully synthesized by using tin(II) chloride dihydrate (SnCl[Formula: see text]H2O), distilled water and liquid ammonia by the simple chemical co-precipitation method at room temperature using different SnCl[Formula: see text]H2O molar concentration of 0.3[Formula: see text]M, 0.4[Formula: see text]M and 0.5[Formula: see text]M. The structural properties of the prepared SnO2and transition metal doped SnO2nanoparticles has been studied using X-ray diffraction method and scanning electron microscope. The composition of the powders has been analyzed using energy dispersive X-ray analysis. The XRD pattern of the SnO2nanoparticles indicates the formation of single-phase rutile tetragonal structure. The grain size is found to be in the range of 3–7[Formula: see text]nm and is found to increase with increasing SnCl2molar concentration. The absorption spectra revealed that the bandgap decreased from 3.74[Formula: see text]eV to 3.59[Formula: see text]eV with increasing SnCl2molar concentration. The photoluminescence spectra of SnO2nanoparticles showed a visible broad luminescence band in the region of 385–430[Formula: see text]nm. The magnetic studies have been carried out using the hysteresis loop obtained from a vibrating sample magnetometer. The SnO2samples using 0.3 and 0.4 SnCl2molar concentration exhibited ferromagnetic behavior whereas the SnO2sample prepared using 0.5[Formula: see text]M SnCl[Formula: see text]H2O exhibited paramagnetic nature.

PD-1 expression is upregulated on adapted T cells in experimental autoimmune encephalomyelitis but is not required to maintain a hyporesponsive state

T cell adaptation is an important peripheral tolerogenic process which ensures that the T cell population can respond effectively to pathogens but remains tolerant to self‐antigens. We probed the mechanisms of T cell adaptation using an experimental autoimmune encephalomyelitis (EAE) model in which the fate of autopathogenic T cells could be followed. We demonstrated that immunisation with a high dose of myelin basic protein (MBP) peptide and complete Freund's adjuvant failed to effectively initiate EAE, in contrast to low dose MBP peptide immunisation which readily induced disease. The proportion of autopathogenic CD4⁺ T cells in the central nervous system (CNS) of mice immunised with a high dose of MBP peptide was not significantly different to mice immunised with a low dose. However, autopathogenic T cells in mice immunised with high dose MBP peptide had an unresponsive phenotype in ex vivo recall assays. Importantly, whilst expression of PD‐1 was increased on adapted CD4⁺ T cells within the CNS, loss of PD‐1 function did not prevent the development of the unresponsive state. The lack of a role for PD‐1 in the acquisition of the adapted state stands in striking contrast to the reported functional importance of PD‐1 in T cell unresponsiveness in other disease models.

A Pilot Feasibility Study in Establishing the Role of Ultrasound-Guided Pleural Biopsies in Pleural Infection (The AUDIO Study)

BACKGROUND

Pleural infection is a common complication of pneumonia associated with high mortality and poor clinical outcome. Treatment of pleural infection relies on the use of broad-spectrum antibiotics because reliable pathogen identification occurs infrequently. We performed a feasibility interventional clinical study assessing the safety and significance of ultrasound (US)-guided pleural biopsy culture to increase microbiological yield. In an exploratory investigation, the 16S ribosomal RNA technique was applied to assess its utility on increasing speed and accuracy vs standard microbiological diagnosis.

METHODS

Twenty patients with clinically established pleural infection were recruited. Participants underwent a detailed US scan and US-guided pleural biopsies before chest drain insertion, alongside standard clinical management. Pleural biopsies and routine clinical samples (pleural fluid and blood) were submitted for microbiological analysis.

RESULTS

US-guided pleural biopsies were safe with no adverse events. US-guided pleural biopsies increased microbiological yield by 25% in addition to pleural fluid and blood samples. The technique provided a substantially higher microbiological yield compared with pleural fluid and blood culture samples (45% compared with 20% and 10%, respectively). The 16S ribosomal RNA technique was successfully applied to pleural biopsy samples, demonstrating high sensitivity (93%) and specificity (89.5%).

CONCLUSIONS

Our findings demonstrate the safety of US-guided pleural biopsies in patients with pleural infection and a substantial increase in microbiological diagnosis, suggesting potential niche of infection in this disease. Quantitative polymerase chain reaction primer assessment of pleural fluid and biopsy appears to have excellent sensitivity and specificity.

Head to head comparison of adverse effects and efficacy between high dose deflazacort and high dose prednisolone in systemic lupus erythematosus: a prospective cohort study

BACKGROUND

Deflazacort (DFZ), an oxazoline derivative of prednisolone (PDN), has a dose equivalence of 1.2:1 (mg) to PDN. No study to date has compared adverse effects and efficacy of high doses of DFZ as against high-dose PDN in systemic lupus erythematosus (SLE).

OBJECTIVES

To compare adverse effects of high dose DFZ and PDN in SLE patients, especially in terms of cushingoid features and gain in body weight, 3 and 6 months after initiation of these agents.

METHODS

In both the steroid arms, the following outcome parameters were assessed at 3 and 6 months: (a) cushingoid features by Cushing's Severity Index (CSI) (b) hirsutism by modified Ferriman Gallwey score (c) weight gain by difference (Δ, delta) of weight (in kilograms).

RESULTS

Patients on PDN had 1.6 kg (3.2%) and 2 kg (5.1%) higher median weight gain as compared to those on DFZ at 3 and 6 months respectively ( p = 0.012 and 0.001). PDN caused 10% and 22.2% higher increment in median hirsutism scores as compared to DFZ at 3 months and 6 months follow-up, respectively ( p = 0.004 and 0.002). PDN caused 100% higher increase in median CSI scores than DFZ at 6 months ( p = 0.03). There was no significant difference by generalized estimation equation between the groups with respect to changes in SLEDAI, renal SLEDAI, anti-dsDNA titres and C3/C4 levels. There were two serious infections (requiring hospitalization/intravenous antibiotics) in the PDN group, while none in the DFZ group.

CONCLUSION

Comparable intake and tapering of high dose DFZ and PDN in active SLE revealed 2-fold less weight gain, 2.5-fold less hirsutism and 1.5-fold lower cushingoid severity index as well as lower glycaemic elevation in the DFZ group as compared to PDN group. Both had similar efficacy.

Dirofilaria repens in scrotum of dogs

Out of 150 apparently healthy male dogs from Kerala, India examined, five revealed single worm in the scrotum. They were found protruding out from beneath the tunica vaginalis when it was incised during the castration operation. Genomic DNA isolated from these worms amplified D. repens specific 246 bp PCR products (KP050552, KP050553). Thickened and enlarged epididymis along with interductal fibrosis, congestion of veins and widening of the cavernous spaces of testes and epididymis were observed in the worm infected dogs. Semeniferous tubules were intact and showed various developmental stages of sperms. The infection resulted in less impact on spermatogenesis.The present communication forms the first report from India on the presence of D. repens in the peritoneal location, which is frequently observed in the subcutaneous locations.

Histoarchitecture of ovary of Haemaphysalis bispinosa during engorgement period

The ovary of Haemaphysalis bispinosa was of panoistic type with asynchronous development of oocytes. The wall of the ovary was composed of a layer of epithelial cells to which the oocytes were attached by means of pedicel cells with elongated nucleus. The oocytes were classified into stages I to V based on morphologic characteristics like size and shape, presence / absence of germ vesicle, cytoplasmic appearance, presence or absence of yolk granules and presence of chorion. Day wise changes were in the form of occurrence of oogonia from partially fed upto day zero of engorgement, presence of all stages of oocytes on day one and two after engorgement and onset of degenerative changes in oocytes from day three onwards. Degeneration was complete on day eight with the appearance of polymorphism, vacuolation, cytoplasmic blebbing and autophagic activity in oocytes.

The exaggerated inflammatory response in Behçet's syndrome: identification of dysfunctional post-transcriptional regulation of the IFN-γ/CXCL10 IP-10 pathway

The mechanisms underlying the exaggerated inflammatory response in Behçet's syndrome (BS) remain poorly understood. We investigated the response of CD14(+) blood monocytes to interferon (IFN)-γ, focusing on the chemokine CXCL10. Chemokine synthesis and release were analysed at a protein and mRNA level following stimulation with IFN-γ. Findings in BS patients were compared with 25 healthy controls (HC), 15 rheumatoid arthritis (RA) and 15 systemic lupus erythematosus (SLE) disease control patients. BS monocytes produced significantly more CXCL10 protein than HC monocytes from 2 h following IFN-γ stimulation, despite equivalent quantities of mRNA, suggesting more efficient translation. This was significantly more pronounced in BS with high disease activity and in those with ocular and neurological clinical manifestations. The imbalance between CXCL10 protein and mRNA expression was not observed in either RA or SLE patients, and was not seen with other chemokines studied (CXCL9, CXCL11 and CCL2). Furthermore, BS monocytes treated with an alternative stimulant (LPS) did not show abnormal tumour necrosis factor (TNF)-α release. Sucrose density gradients to segregate monocyte CXCL10 mRNA into free RNA or polysome-associated RNA showed equal proportions in BS and HC samples, suggesting that the difference between BS and HC may be due to reduced negative control of CXCL10 translation in BS at a post-initiation level. We conclude that BS monocytes have dysfunctional post-transcriptional regulation of CXCL10 mRNA, resulting in over-expression of CXCL10 protein upon IFN-γ stimulation. As CXCL10 is a chemokine that recruits mononuclear cells, this abnormality may contribute to the exaggerated inflammatory responses that characterizes BS.

Acaricidal effects of fenvalerate and cypermethrin against Rhipicephalus (Boophilus) annulatus

The acaricidal effects of two most commonly used acaricides viz., fenvalerate and cypermethrin against Rhipicephalus (Boophilus) annulatus were studied using Adult Immersion Test (AIT). The LC50 values observed for fenvalerate and cypermethrin were 1570 ppm and 184 ppm respectively. The death of ticks was not an immediate process. Fenvalerate caused death only after 7 days while cypermethrin after 5 days of treatment. The eggs laid by treated ticks did not hatch at all concentrations tested.

Tailoring medical education to meet speciality needs

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Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre

Background

The objective of the present study was to determine the prevalence of coronary artery disease (CAD) in patients undergoing surgery for various valvular as well as non-valvular cardiac pathologies.

Methods

Patients with various valvular and non-valvular pathologies were selected. All patients with age ≥40 years and an indication for open heart surgery underwent pre-operative coronary angiogram and were included in the study.

Results

The mean age was 51.5 ± 9.02 years. 178 (59.3%) patients were males and 122 (40.7%) patients were females. Out of 300 patients, 270 (90%) patients had valvular heart disease (VHD) and 30 (10%) patients had non-valvular heart disease. Rheumatic heart disease (RHD), mitral valve prolapse (MVP), degenerative aortic valve disease (DAVD) and bicuspid aortic valve (BAV) was present in 161 (53.7%), 17 (5.7%), 60 (20%) and 32 (10.7%) patients respectively. Overall, 26 (8.7%) patients were found to have significant CAD. CAD was significantly more common in patients with VHD as compared to patients with other etiologies (1 patient, 3.3%, p < 0.05). In the valvular group, DAVD patients had maximum prevalence of CAD (14 patients, 23.4%, p < 0.05). In the group with CAD, the presence of variables such as age >60 years, male sex, typical angina, HT, dyslipidemia and smoking were significantly greater as compared to those with normal coronaries.

Conclusion

The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%), while its prevalence is highest in DAVD (23.4%).

Seroprevalence of bluetongue among domestic ruminants in Northern Kerala, India

The objective of the present study is to assess the seroprevalence of bluetongue (BT) among domestic ruminants of Northern Kerala. Sera samples from cattle (82), goat (40) and sheep (50) collected from districts of Wayanad, Kozhikode and Palakkad respectively were tested using competitive enzyme linked immune-sorbent assay (cELISA). Out of the 172 samples tested, the overall BT seroprevalence was 9.3%. There is an increase in prevalence from previous reports which may indicate possible outbreaks in future.

Acaricidal activity of alkaloid fractions of Leucas indica Spreng against Rhipicephalus (Boophilus) annulatus tick

The acaricidal activity from alkaloid and non-alkaloid fractions of Leucas indica were studied against Rhipicephalus (Boophilus) annulatus tick using adult immersion test under laboratory conditions. For this purpose, the engorged female R.(B.) annulatus tick were exposed to two fold serial dilutions of alkaloid extract (50 mg/ml, 25 mg/ml, 12.5 mg/ml, 6 mg/ml and 3 mg/ml) using 'dipping method' in vitro. The efficacy was assessed by measuring the percentage of adult mortality, inhibition of fecundity and hatching rate. The alkaloid fraction of the extract produced concentration dependent delayed adult tick mortality. The extract at a concentration of 50 mg/ml demonstrated 66.67 per cent mortality and 55.16 per cent inhibition of fecundity. Nicotine was identified as one of the compounds of alkaloid fraction. However, it did not reveal any acaricidal activity when tested in vitro at concentrations ranging from 62.5-1000 μg/mL. Hence, the acaricidal action of L. indica is not due to nicotine. Non alkaloid fraction also did not reveal any acaricidal effects against R. (B.) annulatus tick.

Phylogenetic analysis of bovine Theileria spp. isolated in south India

The objective of the present study is to determine the phylogenetic position of the Theileria organisms in blood of cattle of southern India using molecular tools. Theileria annulata (Namakkal isolate, Tamil Nadu) and three Theileria field isolates (free of T. annulata) from Wayanad, Kerala (Wayanad 1, 2, 3) were used. The small subunit ribosomal RNA (SSU rRNA) and major piroplasm surface protein (MPSP) gene products were cloned, sequenced and the phylogenetic tree constructed. SSU rRNA gene of Wayanad 1 isolate (JQ706077) revealed maximum identity with Theileria velifera or Theileria cervi. The phylogenetic tree constructed based on SSU rRNA genes revealed that Wayanad 1 isolate belonged to a new type which share common ancestor with all the other theilerial species while Wayanad 2 and 3 isolates (JX294459, JX294460) were close to types A and C respectively. Based on MPSP gene sequences, Wayanad 2 and 3 (JQ706078, JX648208) isolates belonged to Type 1 and 3 (Chitose) respectively. When, the previously reported MPSP type 7 is also considered from the same study area, Theileria orientalis types 1, 3 and 7 are observed in south India. SSU rRNA sequence of South Indian T. annulata (JX294461) showed a maximum identity with Asian isolates while the Tams1 merozoite surface antigen (MSA) gene (JX648210) showed maximum identity with north Indian isolate.

Acaricidal effect of Cassia fistula Linn. leaf ethanolic extract against Rhipicephlaus (Boophilus) annulatus

The present study evaluates the acaricidal properties of crude ethanolic extract of Cassia fistula leaves for controlling Rhipicephalus (Boophilus) annulatus based on adult immersion test (AIT). The percentage of adult mortality, inhibition of fecundity and hatching of ova laid were studied at different concentrations of the extract ranging from 50 to 100 mg / ml. The results were compared using one-way ANOVA. The extract produced complete inhibition of hatching of eggs at concentrations above 80 mg / ml of the extract. Mortality of adult engorged female ticks and inhibition of fecundity were concentration dependent. The LC50 value of extract against R. (B.) annulatus was 97.1 mg / ml.

Bovine carriers of Anaplasma marginale and Anaplasma bovis in South India

Carriers of bovine anaplasmosis in Northern Kerala, South India were detected using conventional microscopical and molecular techniques. PCR-RFLP and nested PCR techniques were used for detection of Anaplasma marginale and Anaplasma bovis respectively and the PCR products were confirmed by sequencing. Out of 150 samples tested, 25 were detected positive for A. marginale and five for A. bovis based on molecular tests. The inclusion bodies of A. marginale could be detected by microscopy in two blood smears after staining by giemsa while acridine orange staining detected three smears positive. The data clearly suggest the higher sensitivity of molecular techniques for diagnosis of these diseases.

In vitro evaluation of acaricidal activity of fipronil against Haemaphysalis bispinosa based on adult immersion test

Fipronil is a phenylpyrazole family insecticide which mainly affects the nervous system of insects. In the present study, the in vitro acaricidal effects of the compound against the widely prevalent multihost tick, Haemaphysalis bispinosa was assessed. The lowest concentration at which complete adult tick mortality was observed was at 25 ppm while complete absence of egg mass observed at 10 ppm. Hundred per cent inhibition of fecundity was observed at 1 ppm while complete blocking of hatching of the laid ova was observed even at 500 ppb.

Effects of solvents and surfactants against Haemaphysalis bispinosa

As per the report published by FAO (2004), the tick population in India has developed resistance against all the available acaricides. Hence, newer methods of control including potential herbal agents are required to reduce the problems caused by the ticks. Most of the herbal extracts or their fractions are dissolved in polar or non-polar solvents or detergents before tested for acaricidal activity and these diluents should be of little acaricidal activity. In the present study, adult immersion test (AIT) was carried out on adult engorged female Haemaphysalis bispinosa ticks to detect the acaricidal activity of different solvents viz., nbutanol, glycerol, acetone, ethanol, methanol and surfactants (at 1 per cent dilution) like dimethyl sulphoxide (DMSO), tween 20 and triton X- 100. The study revealed that methanol was the least toxic solvent while tween 20 (1 per cent) was the least toxic detergent against H. bispinosa.

Haemoprotozoa of cattle in Northern Kerala, India

A cross-sectional study was conducted using 150 blood samples collected from apparently normal / healthy crossbred cattle of Northern Kerala, South India, for detection of haemoprotozoan infections using staining techniques (Giemsa and Acridine Orange) and specific PCR. Theileria like piroplasms and Babesia bigemina were the only protozoan organisms detected in blood smears. Polymerase chain reaction using specific primers revealed amplification of products specific for Trypanosoma evansi (34.6%), Theileria sp. other than T. annulata (16%) and B. bigemina (0.6%). The higher prevalence rate of Trypanosoma evansi indicated that the subclinical parasitism can be due to higher prevalence of tabanid flies. The study also revealed the presence of a theilerial piroplasm other than T. annulata in North Kerala, which needs further investigation.

Prevalence of Linguatula serrata in domestic ruminants in South India

Linguatula serrata Frohlich, 1789 is an aberrant endoparasite of occasional zoonotic importance in humans. We report the prevalence of encapsulated nymphal stages of L. serrata in domestic ruminants surveyed in Wayanad, located in Kerala State, South India. Large and small intestine mesentery were examined from 100 goats, cattle and buffaloes each revealing an infection prevalence of 21, 19, and 8%, respectively. The prevalence of L. serrata infection among ruminants is higher than previous reports from India and indicates a strong focus of infection in herbivorous domesticated mammals of South India. The potential importance of these findings to human health is discussed.

Visceral schistosomiasis among domestic ruminants slaughtered in Wayanad, South India

This short communication reports the prevalence of visceral schistosomiasis by worm counts from the mesentery of domestic ruminants of the hilly district of Wayanad, located in Kerala, one of the states in South India. We found 57.3, 50, and 4.7% of cattle, buffaloes and goats, respectively, had visceral schistosomiasis upon slaughter at a municipal slaughter house in Kalpetta. Our findings show that the prevalence of Schistosoma spindale infection is very high in Wayanad in comparison to previous reports from this and neighboring countries.

Bile duct brushings cytology ? improving sensitivity of diagnosis using the ThinPrep�technique: a review of 113 cases

OBJECTIVE

Common bile duct (CBD) brushings have been recognized as a technique of moderate sensitivity and high specificity in identifying carcinoma of the ampulla and pancreatico-biliary regions. This study evaluated the increase in sensitivity of this technique using the ThinPrep technique of specimen preparation when compared with conventional cytology smears.

METHODS

A total of 113 bile duct brushings were included in the study (38 conventional smears and 75 slides prepared using the ThinPrep technique). All slides were reviewed by one cytologist. Five categories of reporting were used: inadequate, negative, atypia, suspicious and malignant.

RESULTS

The inadequate category of reporting disappeared in the ThinPrep group with improved specimen fixation and preparation and hence reduced artefact. Sensitivity of diagnosis of malignancy increased from 39% in conventional smears to 53% in the ThinPrep group. Specificity, positive and negative predictive values and accuracy were 100%, 100%, 60% and 68% for conventional smears and were 100%, 100%, 60% and 72%, respectively, for ThinPrep specimens.

CONCLUSIONS

ThinPrep technique was associated with increased sensitivity of diagnosis, in part due to improved specimen fixation and reduced artefact. Cytology of bile duct brushings is an important diagnostic tool for sites from which it can be difficult to obtain a histology biopsy. It may therefore provide the only opportunity for tissue diagnosis of carcinoma from these sites, hence the importance of optimizing sensitivity.

An unreported complication of acute pancreatitis

Acute pancreatitis constitutes 3% of all admissions with abdominal pain. There are reports of osteal fat necrosis leading to periosteal reactions and osteolytic lesions following severe pancreatitis, particularly in long bones. A 54-year-old man was admitted to our hospital with acute pancretitis, who later developed spinal discitis secondary to necrotizing pancreatitis. He was treated conservatively with antibiotics and after a month he recovered completely without any neurological deficit. This case is reported for its unusual and unreported spinal complications after acute pancreatitis.