A rare case of post-transplant lymphoproliferative disorder (Hodgkins lymphoma) post autologous stem cell transplantation: A case report and review of literature

Introduction

Post-transplant lymphoproliferative disorders(PTLD) include a mix of rare yet life endangering complications.

Case presentation and conclusion

Here, we report a case of a 63-year-old man who was the victim of post-transplant lymphoproliferative disorder (Hodgkin's lymphoma). The patient was initially diagnosed with multiple myeloma, for which chemotherapy and the autologous stem cell transplant was carried out. Post transplant patient was stable but on a follow up visit 6 months after the transplant he presented with generalized lymphadenopathy.

His subsequent workup was done including a biopsy of cervical lymph node, which revealed Classical Hodgkin's lymphoma (post-transplant lymphoproliferative disorder (PTLD)) of mixed cellularity type.

The patient was started on chemotherapy and received a total of 4 cycles of Chemotherapy (ABVD) before his condition started deteriorating as chemotherapy was poorly tolerated leading to Bleomycin toxicity. The patient regrettably passed away due to an NSTEMI.

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Post-transplant lymphoproliferative disorders (PTLD) are a heterogeneous group of major life-threatening complications associated with hematopoietic stem cell transplants (HSCT), bone marrow transplants, and solid organ transplants (SOT) with extremely diversified presentations, classical Hodgkin Lymphoma (cHL)variant of PTLD being the rarest. To the best of our knowledge, this is the first reported case of cHL variant PTLD in a patient of autologous stem cell transplant for multiple myeloma.

•We present a case of Multiple Myeloma that was successfully treated with 3 cycles of bortezomib-based triple therapy (bortezomib, Thalidomide, and dexamethasone) following which autologous stem cell transplantation was performed. 3 years after successful treatment the patient was diagnosed with Classical Hodgkin's lymphoma (post-transplant lymphoproliferative disorder (PTLD)) of mixed cellularity type.

•He was treated with ABVD chemotherapy regimen (Doxorubicin, Vinblastine, Dacarbazine, and Bleomycin), and poorly tolerated the fourth cycle of chemotherapy following which he developed Bleomycin toxicity. The patient, unfortunately, passed away from a sudden episode of Non-ST-Elevation Myocardial Infarction (NSTEMI).

A blistering new era for bullous pemphigoid: A scoping review of current therapies, ongoing clinical trials, and future directions

Bullous pemphigoid (BP) is a severe autoimmune blistering skin disorder that primarily causes disease in the older population and is the most prevalent subepidermal variant of the pemphigoid diseases. It manifests as exquisitely pruritic vesiculobullous eruptions and is associated with significant morbidity and mortality. Studies are reporting an increase in prevalence, and, among the elderly, BP is no longer considered to be as rare as previously thought. The pathogenesis involves autoantibodies directed against proteinaceous components of hemidesmosomes, with consequent autoimmune destruction of the dermal-epidermal junction. In recent times, more complex elements of the underlying inflammatory orchestra have been elucidated and are being used to develop targeted immunotherapies. The primary treatment modalities of BP include the use of topical and systemic corticosteroids, certain non-immunosuppressive agents (tetracyclines, nicotinamide, and sulfone), and immunosuppressants (methotrexate, azathioprine, cyclophosphamide, and Mycophenolate). However, in the long term, most of these agents are associated with substantial toxicities while recurrence rates remain high. Such egregious prospects led to significant efforts being directed towards developing newer targeted therapies which work by attenuating specific newly discovered pillars of the inflammatory pathway, and these efforts have garnered hope in providing safer alternatives. Our review focuses on presenting the various therapeutic options that are currently in trial since December 2019, as well as on summarizing presently established treatment guidelines to provide readers with the latest exciting updates.

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Bullous pemphigoid (BP) is a severe autoimmune blistering skin disorder that primarily causes disease in the older population and is the most prevalent subepidermal variant of the pemphigoid diseases.

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In recent times, more complex elements of the underlying inflammatory orchestra have been elucidated and are being used to develop targeted immunotherapies.

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The present review focuses on presenting the various therapeutic options that are currently in trial since December 2019, as well as on summarizing presently established treatment guidelines to provide readers with the latest exciting updates.

Fungal burn wound infection caused by Fusarium dimerum: A case series on a rare etiology

Introduction

Fusarium dimerum is a filamentous mold associated with poor outcomes in immunocompromised hosts and burn victims. It can be acquired via inhalation or through skin dehiscence.

Methods

Our work presents a Case series of 8 patients from ages 3–57 years who were admitted with multiple burn wounds over the past 6 months. After initial stabilization measures, they all underwent debridement for the lesions after negative initial fungal cultures. The 44-year-old male was the first patient to develop punched-out eruptions on burn areas 7 days after admission; all the other patients experienced similar lesions during the next 6 days. Tissue cultures of the lesions exhibited Fusarium dimerum growth. The patients were managed accordingly with amphotericin B or voriconazoles. All the patients recovered except the 11-year-old boy, who expired on day 9 due to ARDS and sepsis complications.

Outcomes

Infection with Fusarium dimerum carries a high risk of dissemination in burn infections. Hence, appropriate screening should be carried out via histologic and mycologic diagnostics early in the disease course.

Conclusion

Considering the sparse literature that is available regarding Fusarium infection in burn victims, this study aims to improve the knowledge surrounding different facets of this disease including its epidemiology, diagnosis, management, and the need to maintain high suspicion of this fungal disease in burn patients.

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Fusarium dimerum is a filamentous mold associated with poor outcomes in immunocompromised hosts and burn victims. It can be acquired via inhalation or through skin dehiscence.

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Our work presents a Case series of 8 patients from ages 3–57 years who were admitted with multiple burn wounds over the past 6 months. After initial stabilization measures, they all underwent debridement for the lesions after negative initial fungal cultures.

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Infection with Fusarium dimerum carries a high risk of dissemination in burn infections. Hence, appropriate screening should be carried out via histologic and mycologic diagnostics early in the disease course.

GW190521: A Binary Black Hole Merger with a Total Mass of 150 M_{⊙}

On May 21, 2019 at 03:02:29 UTC Advanced LIGO and Advanced Virgo observed a short duration gravitational-wave signal, GW190521, with a three-detector network signal-to-noise ratio of 14.7, and an estimated false-alarm rate of 1 in 4900 yr using a search sensitive to generic transients. If GW190521 is from a quasicircular binary inspiral, then the detected signal is consistent with the merger of two black holes with masses of 85_{-14}^{+21}  M_{⊙} and 66_{-18}^{+17}  M_{⊙} (90% credible intervals). We infer that the primary black hole mass lies within the gap produced by (pulsational) pair-instability supernova processes, with only a 0.32% probability of being below 65  M_{⊙}. We calculate the mass of the remnant to be 142_{-16}^{+28}  M_{⊙}, which can be considered an intermediate mass black hole (IMBH). The luminosity distance of the source is 5.3_{-2.6}^{+2.4}  Gpc, corresponding to a redshift of 0.82_{-0.34}^{+0.28}. The inferred rate of mergers similar to GW190521 is 0.13_{-0.11}^{+0.30}  Gpc^{-3} yr^{-1}.

A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy

Introduction

Fluid therapy in critically ill patients, especially timing and fluid choice, is controversial. Previous randomized trials produced conflicting results. This observational study evaluated the effect of colloid use on 90-day mortality and acute kidney injury (RIFLE F) within the Rational Fluid Therapy in Asia (RaFTA) registry in intensive care units.

Materials and methods

RaFTA is a prospective, observational study in Asian intensive care unit (ICU) patients focusing on fluid therapy and related outcomes. Logistic regression was performed to identify risk factors for increased 90-day mortality and acute kidney injury (AKI).

Results

Twenty-four study centers joined the RaFTA registry and collected 3,187 patient data sets from November 2011 to September 2012. A follow-up was done 90 days after ICU admission. For 90-day mortality, significant risk factors in the overall population were sepsis at admission (OR 2.185 [1.799; 2.654], p < 0.001), cumulative fluid balance (OR 1.032 [1.018; 1.047], p < 0.001), and the use of vasopressors (OR 3.409 [2.694; 4.312], p < 0.001). The use of colloids was associated with a reduced risk of 90-day mortality (OR 0.655 [0.478; 0.900], p = 0.009). The initial colloid dose was not associated with an increased risk for AKI (OR 1.094 [0.754; 1.588], p = 0.635).

Conclusion

RaFTA adds the important finding that colloid use was not associated with increased 90-day mortality or AKI after adjustment for baseline patient condition.

Clinical significance

Early resuscitation with colloids showed potential mortality benefit in the present analysis. Elucidating these findings may be an approach for future research.

How to cite this article

Jacob M, Sahu S, Singh YP, Mehta Y, Yang K-Y, Kuo S-W, et al. A Prospective Observational Study of Rational Fluid Therapy in Asian Intensive Care Units: Another Puzzle Piece in Fluid Therapy. Indian J Crit Care Med 2020;24(11):1028–1036.

Induction of labour with vaginal prostaglandin tablet vs gel

The objective of this study was to compare outcomes in women whose labour was induced with vaginal prostaglandin E2 tablets with those induced with prostaglandin gel. We compared outcomes of induction during two audits conducted in 2005 (PGE2 gel) and 2009 (PGE2 tablets). We found that there was no difference in induction rates; 21% in 2005 and 24% in 2009. The recommended dose of prostaglandin E2 was exceeded in 6% and 17% of women induced with gel and tablets, respectively (p=0.007). There was a difference in use of syntocinon to augment uterine contractions, 39% vs 58% for women induced with gel and tablets, respectively (p=0.001). There was no difference in overall operative delivery, 37% in gel and 38% in tablets. There was no difference in the proportion of women who had vaginal birth within 24 h; 50% vs 42% for gel and tablet, respectively (p=0.187). We conclude that compared to prostaglandin gel, women who received prostaglandin tablets were more likely to require syntocinon to augment contractions.

Study of betasatellite molecule from leaf curl disease of sunn hemp (Crotalaria juncea) in India

Leaves of sunn hemp (Crotalaria juncea) showing geminiviral symptoms were collected from Lucknow, India during rainy season in 2008. DNA template isolated from the symptomatic leaf tissues were subjected to polymerase chain reaction (PCR) using specific primers to amplify coat protein (CP) gene of DNA-A as well as betasatellite DNA associated with the leaf curl disease. CP gene showed 97% sequence identity with that of Cotton leaf curl Burewala virus (CLCuBwV). Further, the betasatellite DNA molecule revealed sequence similarity with previously characterized betasatellite DNA of begomoviruses affecting malvaceous crops from different regions of India and Pakistan. Maximum similarity (>90%) of betasatellite DNA under study was observed with Cotton leaf curl Multan betasatellite (CLCuMB-[Pak: Mul17:08) and other betasatellite DNA from Pakistan thus confirming possible infection of C. juncea with begomovirus. A complementary sense open reading frame (ORF) βC1 is present at nucleotide position 194-550. Sequence comparison of this ORF with other members of begomoviruses further confirmed association of a begomovirus with C. juncea. The betasatellite DNA when expressed under the control of CaMV35S promoter Nicotiana tabacum, showed leaf deformities. Our results demonstrated that a malvaceous betasatellite is adapted by a nonmalvaceous host and causes similar disease symptoms.

Purification and characterization of polynucleotide phosphorylase from cucumber

Polynucleotide phosphorylase (polyribonucleotide:orthophosphate nucleotidyltransferase, EC 2.7.7.8) activity has been found in many prokaryotes and studied in detail since 1955. Such enzymes have been detected also in plants. We now describe the purification of polynucleotide phosphorylase from cucumber cotyledons and leaves. This enzyme is a complex of three subunits, possibly not identical, of about M(r) 50,000. Its enzymatic properties are similar to those of the tobacco enzyme. Unlike the prokaryotic enzymes, the plant enzyme shows activity in the absence of primer but is to various extents stimulated by various ribopolynucleotides or RNAs. RNA-dependent RNA polymerase, not previously shown to exist in non-virus-infected cucumber, has been found to be present at a low level and was separated from the much greater amount of polynucleotide phosphorylase, although some of the physical properties of the two enzymes are rather similar.

Intravesical migration of levonorgestrel-releasing intrauterine system (LNG-IUS) with calculus formation

The intrauterine contraceptive device (IUD) has been in use for many years as an effective means of birth control. Migration of the device from the uterus to the pelvic cavity is not uncommon and has been reported previously, however intravesical migration and secondary calculus formation is relatively rare. We report a 28-year-old woman in whom an intrauterine contraceptive device (LNG-IUS) migrated from the uterus to the bladder and resulted in stone formation. This case shows that the newer hormone releasing IUDs may also cause bladder perforation.

Glucose-induced Akt1 activation mediates fibronectin synthesis in endothelial cells

AIMS/HYPOTHESIS

Increased expression and decreased degradation of extracellular matrix (ECM) proteins are key features of chronic diabetic complications. Fibronectin, a predominant ECM protein, has been shown to be overexpressed in all target organs of diabetic complications and in endothelial cells cultured in high levels of glucose. The present study was designed to elucidate the role of protein kinase B (Akt/PKB) in glucose-induced fibronectin mRNA expression and protein production in vascular endothelial cells.

METHODS

Human umbilical vein endothelial cells were cultured in the presence of high glucose to study Akt/PKB activation. The upstream and downstream mediators in the Akt/PKB pathway were also investigated using dominant negative transfections and specific inhibitors of signalling pathways. Cells were subjected to real time RT-PCR, western blotting, and confocal microscopy to assess Akt1/PKBalpha activation and fibronectin mRNA expression and protein production. To detect transcription factor activation, electrophoretic mobility shift assay was carried out.

RESULTS

Our data demonstrate that fibronectin mRNA expression and protein production that are induced by high glucose are mediated via activation of Akt/PKB, which is modulated by mitogen-activated protein kinase, phosphatidylinositol 3-kinase, and protein kinase C. Glucose-induced fibronectin mRNA expression and protein production are also mediated by Akt1/PKBalpha-dependent activation of the transcription factors nuclear factor-kappaB and activating protein-1.

CONCLUSIONS/INTERPRETATION

Our study provides insight into the mechanical basis of glucose-induced increases in fibronectin mRNA expression and protein production. High levels of glucose may increase fibronectin mRNA expression and protein production by activating Akt/PKB.

Glucose-induced up-regulation of CD36 mediates oxidative stress and microvascular endothelial cell dysfunction

AIMS/HYPOTHESIS

Hyperglycaemia-induced oxidative stress is implicated in the pathogenesis of chronic diabetic complications. Glucose-mediated oxidation of LDL may result in increased oxidative stress and vascular endothelial cell dysfunction via interaction with a cell surface scavenger receptor, CD36. In this study, we investigated the role of CD36 in cultured microvascular endothelial cells (MVECs) and in the heart by using an animal model of chronic diabetes.

METHODS

Cultured MVECs were subjected to varying glucose concentrations and assayed for alteration in CD36 gene expression and protein levels. To assess for oxidised LDL (ox-LDL) uptake, MVECs exposed to low and high glucose were treated with ox-LDL (80 microg/ml), a ligand for CD36. Haem oxygenase-1 (HO-1) and endothelin-1 (ET-1) induction, as well as oxidative stress were determined. The role of glucose-induced CD36 alteration in ox-LDL uptake was also assayed following post-transcriptional CD36 gene silencing. For in vivo studies, CD36 mRNA and oxidative DNA and protein damage were measured in heart tissues of 1-month-old diabetic Sprague-Dawley rats.

RESULTS

We found that glucose increased CD36 mRNA and protein levels in MVECs. High levels of glucose also augmented ox-LDL uptake, in association with increasing HO-1 and ET-1 mRNA levels. CD36 gene silencing prevented glucose-induced CD36 alteration, reduced ox-LDL uptake, and prevented HO-1 and ET-1 up-regulation. Similar to in vitro studies, diabetic heart tissues exhibited increased CD36 mRNA levels and increased oxidative DNA and protein damage.

CONCLUSIONS/INTERPRETATION

Our results provide evidence that up-regulation of CD36 may have a role in increasing oxidative stress in MVECs and the heart in chronic diabetes.

Inhibition of oxalate nephrolithiasis with Ammi visnaga (AI-Khillah)

We investigated the effect of Ammi visnaga seeds on experimentally - induced kidney stones - in male Wistar albino rats. Oxalate nephrolithiasis was experimentally induced by 3% glycolic acid (added in their diet) given for the period of four weeks. A highly significant amount of deposits were found in the kidneys, which were analyzed quantitatively. These deposits were mainly of calcium oxalate in composition. Daily oral (gavage) treatment with Ammi visnaga (500 mg/kg) highly reduced the incidence of nephrolithiasis (calcium oxalate deposition in the kidneys). Ammi visnaga seeds extract showed highly potent diuretic activity. The reduction in body weight, increase in kidneys weight, increase in water intake, decrease in urine output found in glycolic acid control group were prevented to various extent on Ammi visnaga treatment; and the values became to insignificant difference with control group. The changes in weights of liver, heart and lungs of the three groups were insignificant. Uraemia and hyperbilirubinaemia observed in glycolic acid control group were found to be ameliorated by Ammi visnaga seed extract treatment.

Esophageal melanotic schwannoma presenting with superior vena caval obstruction

A rare tumor with an unusual presentation can pose a diagnostic and management dilemma. In this paper, we will discuss the management of a 47-year-old lady with melanotic schwanoma of the esophagus who presented with superior vena caval obstruction. The initial histological diagnosis of esophageal metastatic malignant melanoma did not corroborate the clinical and operative findings. Further evaluation revealed positivity for HMB45, S-100 protein, and vimentin, and confirmed the diagnosis of melanotic schwannoma.

P53 mutation and response to hepatic arterial floxuridine in patients with colorectal liver metastases

PURPOSE

To establish the relationship between the number and site of p53 genomic mutations in metastatic colorectal cancer, and the response to hepatic arterial floxuridine.

METHODS

Liver metastasis biopsies were collected, at the time of laparotomy for hepatic arterial cannulation. in 28 patients with metachronous colorectal liver metastases. p53 Gene mutations were assessed using reverse transcription, nested polymerase chain reaction, single strand conformational polymorphism and gene sequencing. Chemotherapy response was determined from computerised liver tomograms after 4 months of treatment.

RESULTS

Liver metastasis p53 mutation was identified in 21 (75%), and p53 "hot spot" mutation in 11 (39%) patients. There was a significantly lower prevalence (Fisher's, P=0.001) of patients with p53 "hot spot"-mutated liver metastases in stable disease and partial response (5/22) than in progressive (6/6) disease groups. Significantly fewer (Mann-Whitney U, P=0.002) p53 "hot spot" mutations/biopsy were observed in liver metastases from stable disease and partial response (median 0, iqr. 0-0) than in progressive (median 1, iqr 1-2) disease patients. p53 "Hot spot"-mutated liver metastases were associated with significantly shorter survival times (logrank P=0.05) after hepatic arterial floxuridine. Significant response or survival-time differences by total or L2/L3 zinc-binding site p53 mutations were not detected.

CONCLUSIONS

The results support a role for p53 "hot spot" mutations in colorectal liver metastasis resistance to fluorinated pyrimidines, and suggest that the presence of such mutations may be a contra-indication to treatment of colorectal liver metastases with hepatic arterial floxuridine.

Toxicity studies in mice of Commiphora molmol oleo-gum-resin

Acute (24 h) and chronic (90 days) oral toxicity studies on Commiphora molmol (oleo-gum-resin) were carried out in mice. Dosages in acute study were 0.5, 1.0 and 3 g/kg, while in chronic study dosage was 100 mg/kg per day. All external morphological, biochemical and haematological changes, in addition to body and vital organ weights were recorded. There was no significant difference in mortality in acute or chronic treatment as compared to controls. At the end of the treatment, weight gain in the treated as well as control group was significant. There was a significant increase in weight of testes, caudae epididymides and seminal vesicles in C. molmol treated group. Biochemical studies revealed no differences in C. molmol treated animals, however, haematological studies revealed a significant increase in RBC and haemoglobin levels as compared to the control group. C. molmol failed to show any spermatotoxic effects.

P53 mutations in primary and metastatic tumors and circulating tumor cells from colorectal carcinoma patients

Circulating tumor cells could provide a relatively noninvasive and repeatable source of information about tumor cell genotype that might influence treatment and estimation of prognosis. We developed a technique for identifying p53 mutations in tumor cells isolated from the peripheral venous blood of colorectal cancer patients and compared the prevalence and position of these mutations with multiple solid tumor samples from the same patient. We used immunomagnetic beads to isolate tumor cells, reverse transcriptase-nested polymerase chain amplification of the coding region between exons 4 and 9 within the p53 gene, and automated gene sequencing. Nineteen p53 mutations were detected in solid tumor samples from 19 of 41 colorectal carcinoma patients. An identical p53 mutation was invariably present in all samples from primary and metastatic colorectal tumor biopsies within the same patient. p53 mutations were detected in peripheral blood from 8 of these 19 patients with p53-mutated solid tumors. Where identified, the pattern of mutation in peripheral blood samples was invariably the same as in matching solid tumor samples. A single colorectal carcinoma biopsy provided reliable p53 gene mutational information in colorectal carcinoma. Detection of this p53 mutation in tumor cells from peripheral blood was achieved with an approach based on cell selection for epithelial characteristics, reverse transcription-PCR, and gene sequencing.

Increased detection of circulating tumor cells in the blood of colorectal carcinoma patients using two reverse transcription-PCR assays and multiple blood samples

The objectives of this study were to assess whether the use of two reverse transcription-PCR (RT-PCR) cDNA assays and multiple blood sampling increased circulating tumor cell detection in colorectal cancer patients. Systemic blood was sampled three times at 1-min intervals in 100 colorectal cancer patients (50 primary tumors only and 50 liver metastases), and in 70 control patients without known cancer. After removal of the erythrocytes, samples were subjected to separate RT-PCR reactions using specific primers for carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20). Statistical analysis was performed by the two-sample binomial test and the one-sided McNemar test. There were significant increases in circulating tumor cell positivity when CEA and CK20 assays were used together as compared with either CEA or CK20 assay used alone. There were also significant increases in circulating tumor cell positivity for either CEA or CK20 assay used alone when the results from two blood samples were compared with the results from one sample. Circulating colorectal cancer cell positivity rose from 48% (CEA) and 34% (CK20) with one assay of one sample to 74% when both assays of three samples were used to identify circulating tumor cells. Three non-cancer control patients (4.3%) were positive for either CEA (two patients) or CK20 (one patient). Tumor cells were identified more frequently in the circulation of colorectal cancer patients than had been suggested previously. RT-PCR-based studies of the clinical significance of circulating cancer cells in colorectal cancer should involve multiple blood samples with identification of multiple tumor-related cDNA products.

Hormonal profile of infertile Makkans

Male factor infertility, being a complex and heterogeneous disorder, precludes any reliance on a single laboratory test and requires broad spectrum assessment. Sociobiological factors also influence the parameters. In this context we examined serum concentrations of nine hormones in infertile and fertile male Makkans. Infertility was implicated in 21% of the population with correlated abnormalities of gonadotrophins, thyroid, thyroid stimulating hormone (TSH), and testosterone. Hypothyroidism was established in 35% and hyperthyroidism in 14% of the infertile population, where 28% of thyroid abnormality constituted an independent infertile group. Hyperprolactinaemia associated with low levels of luteinizing hormone (LH) and testosterone signifies a cluster of 28%, while 14% of testosterone deficiency alone was causal for infertility. However, infertility in 9% of the patients examined might have been psychogenic in nature. We present a responder panel based on cluster analysis.

The impact of physiological insulin concentration and depletion on the metabolism of glucose, endogenous glycogen, and triglycerides in the isolated perfused heart

In isolated nonworking hearts perfused with substrate-free medium for 90 min, 2000 microU insulin.mL-1 reduced the rates of glycogenolysis and lipolysis, whereas 50 microU insulin.mL-1 reduced the rate of lipolysis with no significant effect on glycogenolysis. Glycogen and triglycerides were the chief energy sources during the course of depletion in the presence and absence of insulin. In hearts perfused with medium containing 5 mM glucose for 3 h, glycogen and triglycerides contributed to the heart energy requirement, but in the presence of insulin (50 or 2000 microU.mL-1) endogenous triglycerides contributed to the heart energy requirement with net glycogen synthesis. In hearts preperfused with substrate-free medium for 90 min and perfused for another 90 min with medium containing 5 mM glucose, the depletion of endogenous glycogen and triglycerides stimulated the utilization of glucose and the synthesis of glycogen and triglycerides. In hearts preperfused with substrate-free medium for 90 min and perfused for another 90 min with medium containing glucose (5 mM) and insulin (50 or 2000 microU.mL-1), insulin enhanced the utilization of glucose and the synthesis of glycogen and triglycerides. Glucose utilization, glycogenolysis, lipolysis, and synthesis of glycogen and triglycerides were sensitive to the physiological insulin concentration and were also affected by the heart content of glycogen and triglycerides, in the isolated nonworking perfused rat heart.

Non-visualization of lung markings below hemidiaphragm in subtle subpulmonic effusion: an old sign resuscitated

To assess the lack of visibility of vascular markings under the hemidiaphragm on a frontal chest radiograph as a sign of pleural effusion, fifteen patients were collected showing this sign. Pleural effusion was diagnosed by ultrasound, comparison with previous or subsequent chest x-ray or computed tomography. Patients in the study group exhibited this sign in the absence of the classical signs of pleural effusion. In the control group, lack of visibility of blood vessels was observed in only 4.2% cases. Non-visualization of vascular markings below the hemidiaphragm should alert the interpreter to the possible presence of pleural effusion and a lateral or decubitus view or ultrasound examination may be carried out to rule out effusion.

Effect of Caralluma tuberculata on the cytological and biochemical changes induced by cyclophosphamide in mice

Treatment with Caralluma tuberculata extract induced complex biochemical and cytological changes in mice. Its cytotoxicity in the bone marrow cells of mice was comparable with that of the standard drug cyclophosphamide (CP); however, unlike CP, C. tuberculata was not clastogenic (as shown by the micronucleus assay). A dose-dependent decrease in the RNA content of liver and testes was produced by C. tuberculata treatment whereas there was no effect on the content of nucleic acid and protein in the brain. In the extract-treated animals there was a significant and dose-dependent increase in the DNA content of the liver, with a negligible effect on the protein content. Combined treatment with C. tuberculata and CP showed that C. tuberculata diminished the effect of CP on DNA levels; however, RNA levels were further suppressed, resulting in increased cytotoxicity. Pretreatment with C. tuberculata extract significantly reduced the clastogenicity of CP. These results indicated the involvement of different phytoconstituents acting by different routes.

RNA-directed RNA polymerases from healthy and from virus-infected cucumber

Much work has been done on the isolation, purification, and characterization of the RNA-directed RNA polymerase (EC 2.7.7.48) of cucumber mosaic virus (CMV)-infected cucumbers. Uninfected plants were reported to have no such enzyme, but we recently detected low levels of the activity in cucumber. Since tobacco and cowpea contain such an enzyme that is variably increased in amount by various virus (as well as viroid) infections, we assumed that this would also be the case upon CMV infection of cucumber. However, further purification and characterization of the RNA-directed RNA polymerases from healthy and from infected cucumber suggests that these are different enzymes. The presumed CMV replicase was obtained pure and consists of a major polypeptide of Mr 100,000 and minor components of Mr 110,000 and about 10,000. The Km is 5 microM ([3H]GTP) when tobacco mosaic virus RNA is used as template.

Clinical and experimental keratitis caused by the Colletotrichum state of Glomerella cingulata and Acrophialophora fusispora

Two cases of mycotic keratitis caused by the Colletotrichum state of Glomerella cingulata and Acrophialophora fusispora are reported for the first time. Both the isolates produced experimental corneal lesions in rabbit eyes but A. fusispora was more pathogenic. The experimental infection was more severe, with both the fungi, in rabbits pretreated with cortisone as compared with untreated animals. In vitro A. fusispora was most sensitive to miconazole and tolciclate followed by clotrimazole, amphotericin B and lactones while clotrimazole exerted maximum inhibitory effect on Colletotrichum followed by miconazole, lactones, amphotericin B and arnebins. Arnebins and tolciclate were inactive respectively against A. fusispora and Colletotrichum. Of the 3 drugs tested in vivo, against A. fusispora keratitis in rabbit, amphotericin B showed better results than tolciclate and miconazole.

Clinical and experimental keratitis due to Curvularia lunata (Wakker) Boedijn var. aeria (Batista, Lima and Vasconcelos) Ellis

A case of mycotic keratitis due to Curvularia lunata var. aeria is reported for the first time from India. Direct microscopic examination of the corneal scrapings in KOH (50 g1(-1)), stained with lactophenol cotton blue, revealed brown septate hyphae and the cultures were found positive for fungus. It was identified as C. lunata (Wakker) Boedijn var. aeria (Batista, Lima and Vasconcelos) Ellis (IMI 253204) and its growth was better at 28 degrees C than at 37 degrees C. In vitro, the fungus was most sensitive to amphotericin B followed by miconazole nitrate, clotrimazole and triphenyltin isoselenocyanate 4-picoline which had the same activity. Lactones were least active and tolciclate and arnebins and inactive. The fungus produced experimental keratomycosis in the rabbit cornea and the infection severity as well as histopathological changes were more pronounced in rabbits that received penicillin, streptomycin and cortisone.