Thrombocytopenia as a Prognostic Marker in Patients with Acute Encephalitis at a Tertiary Care Centre in Northern India

Encephalitis is challenging to manage given the diversity of clinical and epidemiologic features. Various predictors of outcome have been studied so far including thrombocytopenia, cerebral edema, hypoglycaemia, development of status epilepticus and need for endotracheal intubation. Thrombocytopenia represents one of the potentially modifiable risk factors for poor prognosis in encephalitis. A better understanding of the epidemiology of this devastating disease and identification of predictors of outcome and management of reversible factors will pave the way for better management of the disease.

MATERIAL

A total of 98 Hospitalised patients of Acute Encephalitis were enrolled in the study. Diagnoses were confirmed by CSF and Neuroimaging studies. Platelet count <150,000/cumm was considered as thrombocytopenia. Mild, moderate and severe thrombocytopenia was categorized at platelet count 100,000-150,000, 50,000-100,000 and <50,000/ cumm, respectively. Outcome at discharge was assessed using the Modified Ranking Score, categorized into 3 groups - good (0-2), fair (3-4), and poor (5-6). Chi-square, ANOVA and Independent samples 't'-tests were used to compare the data.

OBSERVATION

Mean age of patients was 34.06±18.76 (range 14-85) years. Majority of patients were males (54.1). Mean GCS at admission was 9.41±1.90. Acute viral encephalitis(unclassified) (n=33; 33.7%), Scrub typhus (n=24; 24.5%) and Japanese encephalitis virus (n=12; 12.2%) were the most common underlying etiologies. A total of 74 (75.5%) patients had thrombocytopenia. Mild, moderate and severe thrombocytopenia was seen in 34 (34.7%), 30 (30.6%) and 10 (10.2%) cases. Thrombocytopenia was significantly higher in Dengue and Scrub as compared to other etiologies. Thrombocytopenia and its severity showed a significant association with lower GCS and higher mRS scores indicating a poor outcome.

CONCLUSION

Thrombocytopenia is associated with a poor clinical status and adverse outcomes in patients with encephalitis of all causes.

The origin of the longer wavelength emission in 2-(4-fluorophenylamino)-5-(2,4-dihydroxybenzeno)-1,3,4-thiadiazole and its analogue 2-phenylamino-5-(2-hydroxybenzono)-1,3,4-thiadiazole† ‡

In aqueous solution, 2-(4-fluorophenylamino)-5-(2,4-dihydroxybenzeno)-1,3,4-thiadiazole (FABT) was found to emit dual emission and the longer wavelength emission was assigned to the combination of aggregation and conformational change. In a number of molecules that possess an intramolecular hydrogen bond between the proton donor and the acceptor, the longer wavelength emission is often observed due to the emission from the tautomer formed by excited state intramolecular proton transfer (ESIPT). Therefore, an analogue of FABT, 2-phenylamino-5-(2-hydroxybenzono)-1,3,4-thiadiazole (PHBT), was synthesized to determine the origin of the longer wavelength emission. The luminescence of PHBT and its methoxy derivatives was studied and compared with that of FABT. Theoretical calculations were also performed on both FABT and PHBT. Based on the experimental and theoretical investigations, the nonexistence of the keto tautomer in the ground state and the origin of the longer wavelength emission are divulged.

Mutation Analysis in Chronic Myeloid Leukemia Patient in Chronic Phase on Imatinib Having Delayed Achievement of Milestones or Loss of Response

Tyrosine kinase inhibitors (TKI's) are currently the drug of choice for management of chronic myeloid leukemia. Imatinib is the most commonly used first line TKI in India. Mutations leading to resistance to imatinib are the most common cause for imatinib failure. We studied pattern of kinase domain mutations in 40 patients of CML who either lost their response or did not achieve it in defined timepoints. Loss of molecular response was the most common indication for asking mutation analysis. Sixteen patients were found to have detectable mutations. M351T was the most common tyrosine kinase mutation followed by Y253H and H396R. Two patients had 2 mutations simultaneously. M351T is the most common mutation in our patient population.

Haemostatic Profile in Patients of Myeloproliferative Neoplasms-A Tertiary Care Centre Experience

INTRODUCTION

Patients of MPN commonly present with abnormalities in laboratory coagulation tests that are consistent with hypercoagulable state. Some individuals with MPN exhibit a pattern of exclusive bleeding or thrombotic events; many others have both bleeding and thrombosis during the course of the disease.

AIM

This study was undertaken to assess the haemostatic defects and platelet functions in patients of MPN.

MATERIALS AND METHODS

One year prospective study was conducted at a tertiary care centre in North India in Department of Pathology in collaboration with Department of Clinical Haematology. All recently diagnosed cases of MPN along with 30 age and sex matched controls were included. Patients on antiplatelet drugs, antimyeloproliferative treatment, vitamin K agonists or antagonists, OCPs, Platelet count <1,00,000/μl, high grade fever, liver disease, pregnancy were excluded from this study. All the patients underwent screening investigations like CBC, peripheral smear evaluation, BT, PT, aPTT, Protein C and S measurement (clot based assay) and aggregation studies with ADP (5μM) (Optical Aggregometry with AGGRO/LINK 8 software and CHRONOLOG 700 aggregometer).

RESULTS

In present study, 50 cases were included. There was an occult prothrombotic state, suggested by significantly (p<0.001) reduced levels of Protein C and Protein S, but no patient presented with frank thrombosis while 8 out of 50 patients had haemorrhagic manifestations ranging from subdural haematoma to pin point petechial haemorrhages. Patients of CML-CP, ET, PV, PMF, MPN-NOS showed significantly reduced maximal aggregation with ADP (5μM) when compared to control (p<0.001). MPV also showed a statistically significant increase in these patients.

CONCLUSION

Thrombohaemorrhagic complications significantly affect the morbidity and mortality of MPN patients. This can be assessed by the use of platelet aggregation studies, Protein C and S activities and other coagulation studies. Timely diagnosis of these prothrombotic/haemorrhagic states can decrease the morbidity in these patients.

A randomized study of very low-dose factor VIII prophylaxis in severe haemophilia - A success story from a resource limited country

INTRODUCTION

Current factor prophylaxis strategy practised in developed countries is not feasible in resource constraint developing countries like India.

AIM

The aim of this study was to investigate the efficacy and safety of very low-dose factor prophylaxis in India.

METHODS

Children of 1-10 years of age with severe haemophilia were randomized to Prophylaxis group and Episodic (On demand) group. Children in prophylaxis group received very low-dose factor VIII (FVIII) concentrate, i.e. 10 units kg(-1) body weights on 2 days a week. Episodic group received factor concentrate in standard recommended doses. The study period was 11.5 months.

RESULTS

In total 21 children were enrolled in this study, 11 assigned to prophylaxis and 10 to episodic group. Children on prophylaxis had 11 joint bleeds in comparison to 57 joint bleeds in episodic group. Mean number of haemarthrosis per patient per month were 0.08 (0.08 ± 0.13) in prophylaxis group compared to 0.48 (0.48 ± 0.34) in episodic group (P < 0.05). Total FVIII consumption was 87.51 and 56.32 units kg(-1) month(-1) in prophylaxis and episodic group respectively (P = ns). Overall median hospital emergency visits were 1 day in prophylaxis group and 9 days in episodic group (P ≤ 0.05). Median days of absenteeism from school were 25 days in episodic group and 3 days in prophylaxis group (P < 0.05). No significant complications were noted in prophylaxis group and compliance was 98%.

CONCLUSION

To conclude, low-dose FVIII prophylaxis is cost effective, efficacious and a safe method of preventing joint bleeds and consequent joint damages.

A case of pediatric acute lymphoblastic leukemia with invasive candidiasis: short review

Mortality rate associated with invasive fungal infections is very high. Early suspicion for fungal infections is important during intensive chemotherapy for acute leukemia. Empirical treatment with antifungals amphotericin B or caspofungin should be started if patient is not responding to broad spectrum antibiotics and if expected duration of neutropenia is prolonged. We are reporting a 3 years old girl child with diagnosis of pre-B acute lymphoblastic leukemia who developed invasive candidiasis with typical clinical and radiological findings during induction chemotherapy. Candida non-albicans was isolated and she was treated with amphotericin B followed by caspofungin. Patient deteriorated after initial response and succumbed to death. Species identification and sensitivity pattern of fungus can help in selecting appropriate antifungal drug.

Association of dietary factors and other coronary risk factors with social class in women in five Indian cities

The association between social classes, food intake and coronary risk factors was determined. Cross-sectional surveys were conducted in 6-12 urban streets in each of five cities, each one from five different regions of India using similar methods of dietary intakes and criteria of diagnosis. We randomly selected 3257 women aged 25-64 years inclusive, from Moradabad (n = 902), Trivandrum (n = 760), Calcutta (n = 410), Nagpur (n = 405) and Bombay (n = 780). All subjects, after pooling of data, were divided into social class 1 (n = 985), class 2 (n = 790), class 3 (n = 774), class 4 (n = 602) and class 5 (n = 206) based on various attributes of socioeconomic status. Social class 1 was the highest and 5 was the lowest social class. Social classes 1-3 had greater intake of pro-atherogenic foods; total visible fat, milk and milk products, meat and eggs, as well as sugar and confectionery, compared to social classes 4 and 5. The consumption of wheat, rice, millets, fruits, vegetables and legume/total visible fat ratio were inversely associated with social class. Mean body mass index (BMI), obesity, overweight, central obesity and sedentary lifestyle were also significantly more common among subjects from higher social classes. Spearman's rank correlation showed that bodyweight, BMI, wheat, rice, millets, total visible fat, milk and milk products, meat, eggs, sugar and jaggery intakes were significantly correlated with social class. Social class 5 subjects had a lower intake of all foods and a lower BMI, suggestive of a higher rate of undernutrition among them. The findings indicate that the consumption of pro-atherogenic foods and other coronary risk factors are more common in higher social classes compared to lower social classes.

Rational Use of Recombinant Factor VIIa in Clinical Practice

In the United States, the FDA-approved indications for recombinant factor VIIa is for bypassing inhibitors to factors VIII and IX in patients with hemophilia A and B respectively and for treatment of congenital factor VII deficiency. In European countries, rFVIIa is licensed for the above indications as well as for Glanzmann's thrombasthenia. In absence of high-quality data favoring off-label use of this agent and laboratory test to predict response to this agent, and in view of high cost of rFVIIa, off-label use of recombinant factor VIIa should be restricted to only when hemorrhage has not responded to transfusion or other conventional therapy. It appears, two such conditions where recombinant factor VIIa may be beneficial are traumatic and postpartum hemorrhages.

Abdominal angina: an unusual presentation of Takayasu's arteritis

Takayasu's arteritis (TA) is an idiopathic large vessel vasculitis of young adults that affects the aorta and its major branches. The authors hereby present a case of TA that presented with abdominal aorta thrombosis. She was put on low-molecular weight heparin, antiplatelets, corticosteroids, cyclophosphamide along with haematinics and was referred to Department of Cardiothoracic and Vascular Surgery for further management.

An atypical case of dengue haemorrhagic fever presenting as quadriparesis due to compressive myelopathy

Dengue haemorrhagic fever is a serious presentation of dengue viral infection. Case reports of cerebral haemorrhage due to dengue are rare. The authors report a rare case of dengue haemorrhagic fever presenting with fever and acute onset progressive quadriparesis of the upper motor neuron type. Rare cases of quadriparesis in dengue fever have been reported in the literature due to myositis, Guillain-Barre syndrome, myelitis and hypokalaemia. This case on investigations was found to have extramedullary compression due to haematoma in the cervical region as the cause of quadriparesis.

HIV: a raft-targeting approach for prevention and therapy using plant-derived compounds (review)

It has been widely accepted that HIV-1 enters into and buds out from microdomains known as lipid rafts/caveolae of plasma membranes of infected cells. Since lipid rafts are recognized sites for budding and entry of HIV-1, and since lipids in rafts (including composition/dynamic structure) play a crucial role in modulating the functions of raft-associated signaling proteins and receptors, it has been consistently shown that modulating the composition/structure of lipid rafts have influenced the life cycle of HIV-1 inhibiting its replication. Since anti-retroviral multi-drugs treatment has severe side effects, one of the strategies could be to block the HIV-1 entry and its replication using natural compounds that can target lipid rafts. Dietary and plant-derived compounds have advantage over synthetic drugs exhibiting minimum side effects and are available in cost effective manner. Studies exploring the effects of dietary and plant-derived compounds targeting lipid rafts could be an evolving strategy to control the progression of AIDS. This article is intended to review: (i) composition/structure and conditions for the formation of lipid rafts in plasma membranes, (ii) interaction of HIV-1 with lipid rafts and (iii) to introduce a novel concept that dietary and plant-derived compounds, which can target lipid rafts, could have potential preventive/therapeutic values against the progression of AIDS. More emphasis has been given to the roles of omega-3 fatty acids and plant-derived various triterpenes, especially euphane-types of triterpenes extracted from Neem tree, targeting lipid rafts and its major component cholesterol.

Brain stem auditory evoked responses and visual evoked responses in children with tubercular meningitis

Thirty two patients between 6 months and 14 years of age with tubercular meningitis were evaluated for brain stem auditory evoked response (BAER) and Visual evoked responses (VER), within 7 days of admission. Absolute latencies and interpeak latencies were compared with values obtained from normal children. BAER abnormality was found in 56.25% and VER in 28%children, respectively. BAER abnormality correlated with Glasgow Coma Scale at admission and discharge, stage of meningitis, raised intracranial pressure, seizure activity, and poor outcome. VER abnormality correlated with abnormal fundus findings only.

Suppressed ion chromatography for monitoring chemical impurities in steam for geothermal power plants

A suppressed ion chromatography (IC) technique has been evaluated as a chemical monitoring tool for detecting major anions (F-, Cl-, NO3- and SO4(2-)) of condensed steam in geothermal power plants. It is shown that the suppressed IC technique provides a suitable means for preventing possible damage to generating equipment in the geothermal industry. An electrical conductivity detector (0.1 microS sensitivity) with an anion-exchange column (IonPac AS4A-SC), a micro-membrane suppressor (AMMS II), and an isocratic high-pressure pump system were successfully used for detecting low concentrations of inorganic anions. Method detection limits for the anions of interest were <0.184 mg/L. Details of the IC methodology as well as some experimental results obtained during its application for the chemical monitoring of geothermal steam pipes are also described.

Prevalence of rotavirus diarrhea among outpatients and hospitalized patients: a comparison

The prevalence of rotavirus diarrhea was compared in two settings, among children attending outpatient clinics and those hospitalized (inpatients) at Pune, India. A total of 489 and 628 fecal specimens were collected during October 1993 to September 1996 from outpatients and inpatients respectively. Overall occurrence of rotavirus diarrhea was more among hospitalized children. Using the stratification on the variable age, it is shown that age is indeed a confounding variable. The important finding of the study was, in < or = 6 months age group, it was observed that the occurrence of rotavirus diarrhea was more in the outpatients (30.26%) than among the inpatients (10.11%). Children of this age group are likely to be partially protected by maternal antibodies. The effect of seasonality and sex distribution did not differ in the two settings. It was found that G2 serotype was the major cause of diarrhea among the outpatients.

Capillary electrophoresis for measuring major and trace anions in thermal water and condensed-steam samples from hydrothermal springs and fumaroles

A new application of capillary electrophoresis for measuring major and trace anions in thermal water and condensed-steam samples is presented. Ten fluid samples were collected from hydrothermal springs and fumaroles located in a volcanic zone of Deception Island, Antarctica. Anion separation was achieved in less than 6 min using indirect UV detection at 254 nm with a negative power supply (-15 kV). The electrolyte consisted of 4.7 mM sodium chromate, 4.0 mM electroosmotic flow modifier (OFM) hydroxide, 10 mM 2-(N-cyclohexylamino)ethanesulfonic acid and 0.1 mM calcium gluconate (pH 9.1). Major anions (Cl-, SO4(2), PO4H2+, and CO3H-) were measured using hydrostatic injection (10 cm for 30 s) at 25 degrees C. Trace amounts of anions (F-, Br-, and NO3-) were better determined by electromigration injection (4 kV, 10 s) at 15 degrees C. Good reproducibility of the migration times (<0.72% RSD), a satisfactory linear response and accuracy as well as acceptable detection limits were successfully obtained.

Trace analysis of heavy metals in groundwater samples by ion chromatography with post-column reaction and ultraviolet-visible detection

Groundwaters originating from local and regional aquifers surrounding ash deposits produced by a coal-fired power plant were collected. These water samples were chemically analyzed for quantifying their heavy metal composition at trace levels. A highly sensitive analytical technique based on ion chromatography with a UV-Vis detector and under isocratic eluent flow-rate conditions was used. In order to quantify the major heavy metals (Pb, Cu, Cd, Co, Zn and Ni), three ionic separation column systems were evaluated: (1) a cationic column (HPIC-CS2, Dionex) tested with two eluents (10 mM oxalic acid-7.5 mM citric acid; and 40 mM D-tartaric acid-12 mM citric acid); (2) an anionic column (HPIC-AS4, Dionex) evaluated with 25 mM oxalic acid as eluent: and (3) a bifunctional ion-exchange column (Ionpac CS5, Dionex) which was also tested with two eluents (6 mM pyridine, 2,6-dicarboxylic acid; and 50 mM oxalic acid/95 mM lithium hydroxide). The lowest detection limits achieved with the Ionpac CS5 column and the 50 mM oxalic acid-95 mM lithium hydroxide eluent enabled the heavy metal analysis in groundwater samples to be reliably performed. Details of this comparative study, including the ion chromatography procedure selected and its application to heavy metal analysis of groundwater samples, are presented in this work.

Improved capillary electrophoresis method for measuring rare-earth elements in synthetic geochemical standards

An improved capillary electrophoresis (CE) method for quantifying rare-earth elements (REEs) in synthetic geochemical standards was developed. Synthetic standard solutions were obtained from high purity metal oxides. The separation of REE total group (lanthanum to lutetium) was defined as a primary objective. Special attention was also focused on the optimized separation of europium (Eu) and gadolinium (Gd) because in earlier applications they presented overlapping problems. Their separation and quantitative determinations are essential for geological applications. For the rapid separation of REEs in synthetic geochemical standards, the temperature of the separation device was optimized. An analysis temperature of 15 degrees C enabled both the rapid separation of REEs within 2 min and the overlapping problem of Eu-Gd to be resolved. The detection limits (<0.1 ng) and precision estimates (generally better than 5%) were found to be satisfactory for most geological applications.

Carbamazepine-induced systemic lupus erythematosus presenting as cardiac tamponade

Here we report the case of a patient who presented with acute cardiac tamponade due to drug-induced systemic lupus erythematosus (SLE). The patient had been treated for a seizure disorder with carbamazepine, a drug that has previously been demonstrated to cause SLE-like syndromes. Further serologic analysis demonstrated the likelihood of drug-induced SLE in this patient, with the rare presentation of cardiac tamponade.

Diagnosis and treatment of nephrotic syndrome

Prompt diagnosis is essential in the planning of effective treatment for the underlying diseases responsible for nephrotic syndrome. In this review, the typical clinical and laboratory features that facilitate diagnosis of these disorders are discussed. The distinction between systemic diseases, involving the kidney, and primary glomerular diseases is emphasised. These clinical and pathological distinctions influence prognosis, and form the basis of therapy to treat the underlying disorders. Our discussion focuses on diagnosis and specific treatment of these diseases, as well as therapy of the clinical consequences of nephrotic syndrome per se.

Social class, coronary risk factors and undernutrition, a double burden of diseases, in women during transition, in five Indian cities

OBJECTIVE

To find out the association between social class and coronary risk factors in women.

DESIGN AND SETTING

Cross-sectional surveys were conducted in six-twelve urban streets in each of five cities from various regions of India following a common study protocol and criteria of diagnosis.

SUBJECTS AND METHODS

We randomly selected 3257 women, aged 25-64 years inclusive, from the cities of Moradabad (n=902), Trivandrum (n=760) Calcutta (n=410), Nagpur (n=405) and Bombay (n=780). Evaluation was by questionnaires validated at Moradabad. All subjects, after pooling of data, were divided into social class 1 (n=985), social class 2 (n=790), social class 3 (n=674), social class 4 (n=602) and social class 5 (n=206), based on various attributes of socioeconomic status.

RESULTS

The prevalence of hypertension, diabetes mellitus, family history of coronary disease, obesity, central obesity and sedentary lifestyle were significantly associated with higher social classes and tobacco consumption was not associated with social class. Oral contraceptive intake and postmenopausal status were also more common among higher social classes, which may be due to more education and a longer lifespan among the higher social classes, respectively. Mean total cholesterol, high density lipoprotein cholesterol, systolic and diastolic blood pressure, mean body mass index and waist-hip ratio showed significant association with higher social classes. Mean age, body weight, body mass index, waist-hip ratio, systolic and diastolic blood pressure, total cholesterol and 2-h blood glucose were significantly positively correlated with social class, as assessed by Spearman's rank correlation. Higher social classes 1-3 were more common in Trivandrum and Bombay than in Moradabad. The prevalence of hypertension, diabetes mellitus and being overweight (body mass index >25 kg/m2) were also more common in Trivandrum and Bombay compared to Moradabad. Undernutrition was negatively associated with higher social classes and was more common in Moradabad and Nagpur than Trivandrum.

CONCLUSIONS

Higher social classes among Indian urban women have a higher prevalence of coronary risk factors, hypertension, diabetes mellitus, being overweight, central obesity, sedentary lifestyle, family history of coronary disease, oral contraceptive intake and postmenopausal status. Mean concentrations of total and high density lipoprotein cholesterol were also significantly associated with higher social classes.

The inhibition of the estrogenic effects of pesticides and environmental chemicals by curcumin and isoflavonoids

Many environmental chemicals and pesticides have been found to be estrogenic and have been shown to stimulate the growth of estrogen receptor-positive (ER-positive) human breast cancer cells. Since it is difficult to avoid human exposure to environmental estrogens, a potentially important area of research is the development of dietary strategies to prevent the stimulated growth of breast tumors by environmental estrogens. In this context, the inhibitory action of curcumin and a combination of curcumin and isoflavonoids were studied in ER-positive human breast cancer cells (MCF-7 and T47D) and ER-negative MDA-MB-231 cells induced by the pesticide o,p'-DDT and the environmental pollutants 4-nonylphenol and 4-octylphenol. The median inhibitory concentration (IC50) for curcumin in T47D cells was 10 microM when measured at either a 48-hr or a 6-day incubation time. The IC50 value for curcumin was within the 8-10 microM range for inhibiting the growth of T47D cells induced by a 10- microM concentration each of 4-nonylphenol, 4-octylphenol, and o, p'-DDT. The IC50 for curcumin in MCF-7 cells induced by 10 microM of either o,p'-DDT, 4-octylphenol, or 4-nonylphenol were 9, 39, and >50 microM, respectively. A combination of curcumin and isoflavonoids was able to inhibit the induced growth of ER-positive cells up to 95%. For MDA-MB-231 cells, the IC50 for curcumin was 17 microM, which was reduced to 11 microM in the presence of 25 microM genistein. Curcumin and genistein induce drastic changes in the morphological shape of both ER-positive and ER-negative cells. Data presented here indicate that a mixture of curcumin and isoflavonoids is the most potent inhibitor against the growth of human breast tumor cells. These data suggest that combinations of natural plant compounds may have preventive and therapeutic applications against the growth of breast tumors induced by environmental estrogens.

Effect of soy-derived isoflavonoids on the induced growth of MCF-7 cells by estrogenic environmental chemicals

Isoflavonoids are natural plant compounds and possess antitumorigenic properties. Many environmental chemicals have been found to be estrogenic and can enhance tumor growth in estrogen receptor-positive cells. In the present study, the effects of genistein, daidzein, biochanin A, formononetin, and equol on the proliferation of estrogen receptor-positive MCF-7 cells induced by synthetic chemicals 1-(o-chlorophenyl)-1-(p-chlorophenyl)-2,2,2-trichloroethane (o,p'-DDT), 4-nonylphenol (4-NP), and 5-octylphenol (5-OP) found in the environment were investigated. Genistein, biochanin A, equol, and to some extent daidzein, but not formononetin, at < 10 microM can enhance the growth of MCF-7 cells in the absence of environmental chemicals. Formononetin was toxic to MCF-7 cells at the tested concentrations. The environmental chemicals 4-NP, 5-OP, and o,p'-DDT and the natural estrogen 17 beta-estradiol at 5, 5, and 10 microM and 5 nM, respectively, induced proliferation of MCF-7 cells. In the presence of isoflavonoids (> 25 microM), the environmental chemical-induced cell proliferation was inhibited. Individually, genistein (IC50 = 25-33 microM) was the most potent inhibitor against the induced proliferation of MCF-7 cells of the isoflavonoids needed for a 50% suppression of growth induced by 4-NP, 5-OP, and o,p'-DDT. A mixture of isoflavonoids was the most potent inhibitor against the induced proliferation. Estrogen receptor-dependent and -independent pathways could be involved in the inhibitory actions of isoflavonids. Because it is impossible to have a chemical-free environment, the in vitro data presented here are of practical importance to develop evolving dietary strategies and tactics against the adverse health effects of environmental chemicals.

Comparative pharmacokinetics of amikacin following a single intramuscular or subcutaneous administration in goats (Capra hircus)

The pharmacokinetics of amikacin sulfate was investigated following a single intramuscular (i.m.) or subcutaneous (s.c.) administration (10 mg/kg). The plasma concentration versus time data were analysed using the biexponential equation for first-order absorption and elimination phases for both the i.m. and s.c. routes. The absorption half life values for the i.m. and s.c. routes were found to be 14.64 and 12.36 min, respectively. The biological half-life values of amikacin following i.m. and s.c. routes were found to be 84.46 and 93.96 min, respectively. The systemic availability of amikacin for both the i.m. (102.15 +/- 5.08%) and s.c. (106.82 +/- 12.95%) routes was found to be almost complete. Thus, based on the data of short absorption half life, almost complete systemic availability, slightly longer biological half life and ease of administration, we suggest that the s.c. route be preferred over the i.m. route for amikacin administration in goats. Amikacin at a dose level of 8 mg/kg body weight at 12 h intervals would result in a therapeutic peak plasma concentration (Cpmax) of 32.30 micrograms/mL, which is not expected to produce any oto- or nephropathic effects.

Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India

OBJECTIVE

This study was conducted to determine and compare the prevalence of coronary artery disease and coronary risk factors in both a rural and an urban population of Moradabad in north India.

DESIGN AND SETTING

A cross-sectional survey of two randomly selected villages from the Moradabad district and 20 randomly selected streets in the city of Moradabad.

SUBJECTS AND METHODS

The 3575 subjects were between 25 and 64 years old; 1769 (894 men and 875 women) lived in the countryside and 1806 (904 men and 902 women) lived in the city. The survey methods were questionnaires, physical examination and electrocardiography.

RESULTS

The overall prevalence of coronary artery disease, based on a clinical diagnosis and an electrocardiogram, was 9.0% in the urban and 3.3% in the rural population. The prevalences were significantly (P < 0.001) higher in the men compared with the women in both urban (11.0 vs 6.9%) and rural (3.9 vs 2.6%) populations, respectively. The prevalence of symptomatic coronary artery disease (known coronary disease and Rose questionnaire-positive angina) was 2.3% in the men (n = 19) and 1.5% in the women (n = 13) in the rural subjects, and 8.5% in the men (n = 77) and 3.4% in the women (n = 31) in the urban population. When diagnosed on the basis of electrocardiographic changes alone, the prevalences were 1.5% (n = 26) in the rural population and 3.0% (n = 55) in the urban. Coronary risk factors were two- or three-fold more common among urban subjects compared to the rural population in both sexes. Central obesity was four times more common in the urban population compared to the rural in both sexes. Sedentary lifestyle and alcohol intake were significantly (P < 0.01) higher in the urban population compared to the rural subjects. There was a significant association between coronary disease and age, hypercholesterolaemia, hypertension and central obesity in both sexes. Smoking was a significant risk factor of coronary disease in men.

CONCLUSIONS

Coronary artery disease and coronary risk factors were two or three times higher among the urban compared with the rural subjects, which may be due to greater sedentary behaviour and alcohol intake among urbans. It is possible that some Indian populations can benefit by reducing serum cholesterol, blood pressure and central obesity and increasing physical activity.

Curcumin and genistein, plant natural products, show synergistic inhibitory effects on the growth of human breast cancer MCF-7 cells induced by estrogenic pesticides

Curcumin and genistein are two natural products of plants obtained from Curcuma longa Linn (turmeric) and soybeans, respectively. Both compounds when present at micromolar concentrations are able to inhibit the growth of estrogen-positive human breast MCF-7 cells induced individually or by a mixture of the pesticides endosulfane, DDT and chlordane or 17-beta estradiol. When curcumin and genistein were added together to MCF-7 cells, a synergistic effect resulting in a total inhibition of the induction of MCF-7 cells by the highly estrogenic activity of endosulfane/chlordane/DDT mixtures was noted. These data suggest that the combination of curcumin and genistein in the diet have the potential to reduce the proliferation of estrogen-positive cells by mixtures of pesticides or 17-beta estradiol. Since it is difficult to remove pesticides completely from the environment or the diet and since both turmeric and soybeans are not toxic to humans, their inclusion in the diet in order to prevent hormone related cancers deserves consideration.

Raman spectroscopic evidence for structural changes in poly-L-lysine induced by an approximately 50 mT static magnetic field

We have explored the mechanism of coupling of an approximately 50 mT static magnetic field with the alpha helices of poly-L-lysine. Structural changes in poly-L-lysine were determined by Raman spectroscopy. Our testable hypothesis is that static magnetic fields of this magnitude can couple with the alpha-helical segments of the polypeptide, and, as a result, the structure of the polypeptide is significantly altered. Our model further suggests that a static magnetic field can promote protein unfolding and can prevent refolding.

Multiple anthelmintic resistance in Haemonchus contortus on a sheep farm in India

Multiple resistance to benzimidazoles (fenbendazole, albendazole and mebendazole) in a strain of Haemonchus contortus in sheep was detected on a farm where fenbendazole resistance had already been identified. Following a faecal egg count reduction test, this was confirmed by both critical and controlled anthelmintic tests. Different groups of sheep infected naturally or given an experimental infection with the fenbendazole-resistant strain were treated with the recommended doses of various anthelmintics. Compared to the control group, percentage reductions in faecal egg counts of sheep treated with fenbendazole, albendazole, mebendazole, levamisole and morantel varied between 56% and 81% and worm counts between 71% and 86%. The results indicate the presence of multiple anthelmintic resistance in this strain of H. contortus on this farm. Sheep treated with ivermectin and closantel showed 100% reductions in faecal egg and worm counts, suggesting high efficacy of these drugs against the population of H. contortus on this farm.

Pharmacokinetics of gentamicin following single-dose parenteral administration to goats

The disposition kinetics of parenterally administered gentamicin (5 mg kg-1) has been studied in Gaddi goats. The serum concentration-time profile was described by bi-exponential and mono-exponential equations following intravenous (i.v.), intramuscular (i.m.) and subcutaneous (s.c.) administration with elimination half-life values of 0.96 +/- 0.09, 2.37 +/- 0.47 and 3.56 +/- 0.39 h, respectively. The apparent volume of distribution following i.v. administration (Vdarea: 0.26 +/- 0.041 kg-1) reflected limited extracellular distribution of the drug. The bioavailability was higher following i.m. administration (96.3%) compared to s.c. (76.9%). In view of the significantly longer biological half-life and larger area under the curve values, the s.c. route may be preferred. It is concluded that a suitable and practical dosage recommendation for gentamicin in goats would be 3.35 mg kg-1 body weight given s.c. at 12 h intervals.

Coronary angioplasty in high risk patients with percutaneous cardiopulmonary support

Cardiopulmonary Support (CPS) was employed electively in 13 patients during high risk percutaneous transluminal coronary angioplasty (PTCA) in accordance with a selection criteria, which included at least two of the following; (i) left ventricular ejection fraction of less than 35%, (ii) target vessel(s) supplying more than 50% of the viable myocardium, and (iii) patients refused coronary bypass surgery. The mean age of the patients was 56.8 +/- 10.7 years (range 39-77). PTCA was attempted in a total of 35 lesions in 12 patients; 29 lesions were successfully dilated (technical success rate of 82.9%). On average, 2.7 lesions were attempted in each patient, and 2.2 lesions were successfully dilated per patient. In one patient the procedure was abandoned due to dissection of the iliac artery during cannulation. One patient died of a large pulmonary embolism 72 h after the procedure. All the surviving 11 patients who had successful PTCA on CPS showed symptomatic improvement during a mean follow-up period of 18.5 +/- 4.3 months (range 11 to 24 months). The commonest complication encountered following the CPS-assisted PTCA was local haematoma (nine of 13 patients), but all patients required transfusion due to significant periprocedural blood loss. Our early experience suggests that CPS enhances the safety of undertaking PTCA in high risk patients.

Balloon angioplasty of totally and subtotally occluded coronary arteries: results using the Hydrophillic Terumo Radifocus Guidewire M (glidewire)

Balloon angioplasty was attempted, using hydrophillic Terumo guidewires, in 52 totally and subtotally occluded coronary arteries (50 patients), in which recanalisation by conventional angioplasty guidewires had failed. Hydrophillic guidewires had a crossing success rate of 65.4% (34/52); there was subsequently a technical success rate of 56% (29/52) and clinical success of 39% (20/52). Dissection of the coronary artery was seen in 16/29 technically successful cases. In 12/16 arteries, dissection was small and localised, whereas in 4/16 large and extended distally. There was one myocardial infarction and no peri-procedural deaths. Eleven out of 29 technically successful cases continued to be regarded as successful 12 mo postangioplasty. We conclude that the hydrophillic Terumo guidewire can improve the success rate in angioplasty of totally and subtotally occluded coronary arteries when conventional wires have failed.

Indirect excitatory actions of histamine on isolated chicken oesophagus

The histamine-induced contraction on chicken oesophagus was antagonised non-competitively by atropine, hexamethonium, cocaine, methysergide, indomethacin, theophylline and verapamil. Physostigmine slightly potentiated the excitatory action of histamine. These results indicate that histamine excreted its excitatory action by involving a number of mechanisms as suggested in guinea pig oesophagus.

Fast magnetic resonance angiography using turbo-FLASH sequences in advanced aortoiliac disease

A prospective study using contrast enhanced turbo-FLASH (Fast Low-Angle Shot) magnetic resonance (MR) angiography was performed to assess the arterial anatomy in patients who had advanced atherosclerotic aortoiliac disease. This new imaging sequence was employed in 17 patients and the results were compared with conventional abdominal aortography. MR angiography accurately detected all aortic occlusions (3/3), their sites and their extent. All nine iliac occlusions were correctly identified (sensitivity 100%, specificity of 90%). The sensitivity was 100% for stenosis of 50% or greater in the abdominal aorta, and the iliac and common femoral arteries. The degree of stenosis was overgraded in 20 of 51 lesions (39.2%). Mild stenosis was overgraded as moderate stenosis in 10 and as severe stenosis in three. Moderate stenosis was overgraded as severe stenosis in four. None of the mild or moderate stenoses resulted in areas of signal voids suggestive of occlusions. Three severe stenoses were seen as areas of signal voids (two iliac, one femoral). In the eight patients who had in total 10 aneurysmal dilatations of the aorta or the iliac arteries, MR angiography was superior in demonstrating the true extent of the aneurysms. We conclude that turbo-FLASH MR angiography has the potential to be a useful non-invasive imaging technique for patients with advanced aortoiliac disease.

Ionizing radiation target groups of band 3 inserted into egg lecithin liposomes as determined by Raman spectroscopy

The purified integral membrane protein, band 3, from human erythrocytes was inserted into egg lecithin liposomes. The insertion of band 3 was determined from thermal transition data from the analysis of the C--H stretching region bands recorded at temperatures from 25 to -22 degrees C. Raman spectra show that band 3 considerably broadens and lowers the thermal transition of egg lecithin liposomes, suggesting the insertion of band 3. The band 3-inserted liposomes were irradiated with gamma-rays (40 Gy) and the radiation target groups were determined by the analysis of the structural sensitive Raman bands in the 1600-1700 cm-1 (amide I), 1200-1300 cm-1 (amide III) and 550-1030 cm-1 (side chain amino groups) regions. The radiation-sensitive groups as identified from Raman spectra in the region 550-1030 cm-1 are tyrosines and cysteines. The radiation-induced changes in the secondary structure were determined from amide I and III bands. Quantitative estimation using the curve fitting method shows that band 3 contains 44% total helix, 48% beta strand and 8% undefined plus turns (error +/- 4%). The secondary structure changes to 35% total helix, 42% total beta-strand and 23% turned and undefined upon irradiating band 3 containing liposomes. We suggest that ionizing radiation preferably damages tyrosine and cysteine side chain residues and reduces the amount of alpha-helical configuration of band 3.

Hexachlorocyclohexane pesticides reduce survival and alter plasma membrane structure of Chinese hamster V79 cells

We studied the cytotoxic effects of alpha-, beta-, gamma-, and delta-hexachlorocyclohexanes (HCCH) on the survival of Chinese hamster V79 cells using clonogenic assays. Lethal dose yielding 50% cell survival (LD50) suggests the following order of cytotoxicity: delta-(+)gamma-HCCH (LD50 4 micrograms/ml) (1:1, w/w, mixture) > delta-HCCH (LD50 6 micrograms/ml) > gamma-HCCH (LD50 13 micrograms/ml) > alpha-HCCH (LD50 approx. 35 micrograms/ml) >> beta-HCCH. Structural changes in plasma membranes prepared from HCCH-treated V79 cells at dose yielding 10% cell survival (LD10) were analyzed using Raman spectroscopy. Raman spectra of plasma membranes show bands at 2850, 2880-2890, and 2935 cm-1 in the C-H stretching region. The plot of the ratio (I2880-2890/I2850) vs temperature for control plasma membranes shows two transitions between -5 and 5 degrees C and between 12 and 20 degrees C. Plasma membranes prepared from gamma- and delta-HCCH-treated Chinese hamster V79 cells show single transitions between -4 and 11 degrees C and between -2 and 11 degrees C, respectively. These changes in the thermal transition properties suggest that both gamma- and delta-HCCH alter lipid and lipid-protein phases of the plasma membrane of V79 cells. Raman analysis of the amide I and amide III region spectra further suggest that delta-HCCH also alters the secondary structure and the environment of highly amidated segments of plasma membrane proteins. We suggest that the primary action of biologically active HCCH isomers is to disrupt the organization of the plasma membrane and that may affect cell viability.

Cardiac resuscitation with percutaneous cardiopulmonary support

Percutaneous cardiopulmonary support (CPS) was initiated in 9 patients to provide haemodynamic stability after failure of conventional resuscitation. 4 patients were in cardiogenic shock and 4 remained in asystole, with 1 in resistant ventricular fibrillation, after cardiac arrest. During CPS for those in cardiogenic shock, the mean intra-arterial pressures ranged from 65 to 100 mm Hg (mean 84), at flow rates of between 3 to 5 l/min (mean 3.9). 2 patients underwent technically successful coronary angioplasty. No patient in this group survived. In the cardiac arrest group, acceptable mean intra-arterial blood pressures were achieved (mean 95, range 90-100 mm Hg) at flow rates of between 2 to 3 l/min (mean 2.6). All 5 subjects underwent technically successful coronary angioplasty whilst on CPS. 4 survived. 2 were alive and well at 12 months follow-up, 1 of whom had returned to work; the third is alive and well at 4 months.

Vasodilator therapy for acute heart failure: haemodynamic comparison of hydralazine/isosorbide, alpha-adrenoceptor blockade, and angiotensin-converting enzyme inhibition

Haemodynamic comparison of three vasodilation regimens [intravenous (i.v.) hydralazine and isosorbide dinitrate (ISDN) combined, i.v. doxazosin, and i.v. enalaprilat] was undertaken in 36 patients with acute left ventricular (LV) failure due to recent myocardial infarction. Each regimen achieved similar reductions in pulmonary artery occluded pressure (PAOP, preload) and systemic arterial pressures (afterload), with increased cardiac and stroke volume (SV) indexes (p less than 0.01). Only the hydralazine and isosorbide combination induced resting tachycardia. Balanced vasodilatation after selective alpha-adrenoceptor blockade (doxazosin) and angiotensin-converting enzyme (ACE) inhibition (enalaprilat) without increase in heart rate (HR) suggests that these therapies may have definite haemodynamic advantages over the hydralazine/ISDN combination.

Modulation of inotropic therapy by venodilation in acute heart failure: a randomised comparison of four inotropic agents, alone and combined with isosorbide dinitrate

The effects of four inotropic agents with differing ancillary properties [a cardiac glycoside (digoxin), a combined alpha- and beta-adrenergic agonist (dobutamine), a beta-adrenergic agonist (prenalterol), and a phosphodiesterase inhibitor (amrinone)] alone and with subsequent addition of isosorbide dinitrate were compared in 48 consecutive acute myocardial infarction patients with radiographic and haemodynamic (pulmonary artery occluded pressure greater than 18 mm Hg) left ventricular failure. All agents with the exception of dobutamine reduced the elevated left heart filling pressure; only digoxin and dobutamine augmented the cardiac stroke volume index. All drugs except digoxin reduced the SVRI; an arteriolar constrictor response was evident 60 min after digoxin and a tachycardia resulted after combined alpha- and beta- and beta-adrenergic stimulations (dobutamine and prenalterol, respectively). The addition of isosorbide dinitrate reversed the inotrope-induced elevations of systemic arterial pressure and resulted in additional reductions in left heart filling pressure. These data suggest that, in the absence of substantial venodilator properties in an inotropic compound, reduction in elevated left heart filling pressure is not achieved with inotropic therapy alone in acute left ventricular failure and combining a venodilator may be haemodynamically advantageous.

Low levels of the pesticide, delta-hexachlorocyclohexane, lyses human erythrocytes and alters the organization of membrane lipids and proteins as revealed by Raman spectroscopy

We studied the nature of the interaction of delta-hexachlorocyclohexane (delta-HCCH), a pesticide having a stereoisomeric structure similar to inositol, with red blood cells. Cell survival data, measured as percent of hemoglobin released by delta-HCCH, show that the cell lysis increases with post exposure time. delta-HCCH at 55-60 micrograms/ml causes about 70% cell lysis after 24 h of exposure. The nature of interaction of delta-HCCH with membrane components was evaluated by studying the thermotropic transitions and protein structure of ghosts using Raman spectroscopy. Control ghosts show transitions with onset/completion temperatures 30 degrees C/38 degrees C (high temperature transition) and 3 degrees C/10 degrees C (middle temperature transition) when monitored by the I2935/I2850 ratio. The interaction of delta-HCCH drastically broadens the high temperature transition and shifts it to the temperature range of 10-29 degrees C. The plots of (I2880-90/I2850) vs. temperature show two transitions for control ghosts, one extending from -10 degrees C to 3 degrees C (lower temperature transition) and the other from about 7 degrees C to about 15 degrees C (middle temperature transition). Ghosts lysed with delta-HCCH shows only a single and a very broad transition in the range of about -3 degrees C to about 15 degrees C. These changes in the thermal transition properties suggest that delta-HCCH alters lipid and lipid-protein phases of erythrocyte membranes. The comparison of Raman spectra in the amide I and III regions of erythrocyte ghosts and purified band 3 with several amidated compounds reveals that cytoskeleton proteins contain highly amidated residues (probably glutamine and asparagine). The interaction of delta-HCCH with erythrocytes drastically alters the environment of these amidated residues indicating the involvement of cytoskeleton proteins. We conclude that the interaction of delta-HCCH with red blood cells disrupt membrane structure and change the environment of cytoskeleton proteins that could cause cell lysis.

Hemodynamic interactions of a new beta blocker, celiprolol, with nifedipine in angina pectoris

The hemodynamic consequences of blockade at both beta-adrenoceptors and slow calcium channels is of therapeutic importance for patients with angina pectoris. The hemodynamic interaction of a new cardioselective beta blocker, celiprolol, and nifedipine was examined in an acute hemodynamic study using three prospectively matched groups with angiographically confirmed coronary artery disease (n = 10/group). Patients were randomly allocated to intravenous celiprolol (8 mg), sublingual nifedipine (20 mg), or their combination. Rest and exercise (supine bicycle) hemodynamics were determined before and following each therapy. At rest, celiprolol did not alter pumping function; nifedipine reduced diastolic blood pressure and systemic vascular resistance index (SVRI), with a small increase in heart rate. Combination therapy reduced systemic arterial pressure and SVRI; heart rate and cardiac stroke volume index increased. During exercise celiprolol tended to reduce heart rate and cardiac index; nifedipine reduced exercise SVR and cardiac stroke work indices. Combination therapy reduced all components of blood pressure; cardiac stroke work and SVR indices fell. These hemodynamic data suggest that beta blockade with celiprolol may result in a slight depression of cardiac pumping during exercise; however, such effects are offset by the vasodilating actions of nifedipine (reflex sympathetic action offsetting cardiodepression). Thus the acute hemodynamic effects of this combination were seemingly safe in these patients; the longer term effects during maintained therapy should be further assessed.

Structural changes in plasma membranes prepared from irradiated Chinese hamster V79 cells as revealed by Raman spectroscopy

The effect of gamma irradiation on the integrity of plasma membranes isolated from Chinese hamster V79 cells was investigated by Raman spectroscopy. Plasma membranes of control V79 cells show transitions between (-) 10 and 5 degrees C (low-temperature transition), 10 and 22 degrees C (middle-temperature transition), and 32 and 40 degrees C (high-temperature transition). Irradiation (5 Gy) alters these transitions markedly. First, the low-temperature transition shifts to higher temperature (onset and completion temperatures 4 and 14 degrees C). Second, the middle-temperature transition shifts up to the range of about 20-32 degrees C, but the width remains unchanged. Third, the higher temperature transition broadens markedly and shifts to the range of about 15-40 degrees C. Protein secondary structure as determined by least-squares analysis of the amide I bands shows 36% total helix, 55% total beta-strand, and 9% turn plus undefined for control plasma membrane proteins. Plasma membrane proteins of irradiated V79 cells show an increase in total helix (40 and 45% at 5 and 10 Gy, respectively) and a decrease in the total beta-strand (48 and 44% at 5 and 10 Gy, respectively) structures. The qualitative analysis of the Raman features of plasma membranes and model compounds in the 1600 cm-1 region, assigned to tyrosine groups, revealed that irradiation alters the microenvironment of these groups. We conclude that the radiation dose used in the survival range of Chinese hamster V79 cells can cause damage to plasma membrane proteins without detectable lipid peroxidation, and that the altered proteins react differently with lipids, yielding a shift in the thermal transition properties.

Post-epidemic serological survey for JE virus antibodies in south Arcot district (Tamil Nadu)

Following an extensive epidemic of Japanese encephalitis (JE) in 1981, a serological survey was carried out in the South Arcot district of Tamil Nadu in April 1982. Serum specimens were obtained from 10 villages with serologically proven infections and 6 villages with no reported case of encephalitis during the 1981 epidemic. The serum specimens tested for haemagglutination inhibition, complement fixing and neutralizing antibodies, showed a high prevalence of JE (49.17%), West Nile (40.78%) and dengue (18.14%) viruses with predominance of JE. The prevalence did not differ between the villages with or without Japanese encephalities. There was also no difference between the family members and neighbours.

Pharmacokinetics and urinary excretion of gentamicin in Bubalus bubalis calves following intramuscular administration

The pharmacokinetics and urinary excretion of gentamicin was studied in buffalo calves after a single intramuscular administration (10 mg kg-1). Kinetic determinants were calculated by using a two compartment open model. The absorption (t1/2Ka) and biological half lives (t1/2 beta) were calculated to be 0.43 +/- 0.08 and 3.79 +/- 0.23 h, respectively. The value of the apparent volume of distribution (VdB) was found to be 0.38 +/- 0.07 litre kg-1. The satisfactory intramuscular dosage regimen of gentamicin for buffalo calves would be 3.23 mg kg-1 as priming dose and 2.88 mg kg-1 as maintenance dose to be repeated at 12 hour intervals to achieve and maintain the therapeutic plasma levels within safe limits. Urinary excretion of gentamicin was very rapid during the first 12 hours as 48.07 +/- 1.39 per cent of the total administered dose was excreted unchanged during this period.