Early response to chemotherapy in children with Langerhans cell histiocytosis predicts long-term disease-free survival

Background: Langerhans cell histiocytosis (LCH) is a rare clonal malignancy of the monocyte-macrophage system. Patients with lesions in 搑isk organs� have significantly higher risk of mortality than patients with lesions limited to 搉on-risk� sites. The influence of early response to therapy on long-term survival in this heterogeneous multi-system disease was analyzed. Methods: During a 7-year period, we retrospectively analyzed the findings in 24 consecutive patients who required systemic chemotherapy for LCH [single system with multifocal bone involvement and multisystem involvement with or without risk organ (RO) involvement]. All patients were started on vinblastine and prednisolone. Progressive disease was treated with salvage protocols or targeted therapy. Positron emission tomography-computed tomography (PET-CT)/conventional CT based response assessment was performed at week 6 of chemotherapy, and if needed after week 12 of chemotherapy. Results: MFO bone, MS ROneg, and MS ROpos LCH was observed in 3, 4, and 17 patients, respectively. Age range of patients varied from 1 month�years (median = 18 months). The EFS and OS were 100% and 100% for MFO bone, 50% and 100%, respectively, for MS ROneg and 35% and 52%, respectively, for MS ROpos. OS was 93% and 100% for CR attained at 6 and 12 weeks respectively regardless of the risk status (P < 0.01). Conclusion: Rapid early response, that is, complete remission at 6 and 12 weeks was associated with significantly improved overall survival. In slow responders, early salvage with alternative regimens or targeted therapy may result in better outcomes

Colo-Colic Intussusception as the Presenting Feature of Neutropenic Typhlitis during Induction Phase of Acute Lymphoblastic Leukemia in an 8-Year-Old Child / 임상소아혈액종양

Acute lymphoblastic leukemia (ALL) is the most common malignancy of children.Gastrointestinal complications can occur during treatment of these children due to disease infiltration in gut or treatment-related toxicity. Intestinal obstruction is one of these complications and this occurs mostly due to constipation and impacted stool. Intussusception is a very rare entity in children with ALL. Left sided colo-colic intussusception is even rarer. Most of the intussusceptions are ileo-colic and are associated with a lead point. We present a case of left sided colo-colic intussusception in an 8-year-old child with ALL. There was no lead point or leukemic infiltrate in the resected part of the intussusception. Our child had typhlitis leading to intussusception which is a very rare occurrence. Awareness regarding this complication with ALL is important for prompt diagnosis and treatment.

Evaluation of anti-histidine-rich protein 2 monoclonal antibodies, developed by using poly (N-isopropylacrylamide) as an adjuvant for malarial diagnostic application

@#Objective: To evaluate the sensitivity and the stability of the monoclonal antibodies (Aa3c10, b10c1), against truncated Histidine-rich protein 2 (PfHRP2), developed using smart polymer, poly N-isopropylacrylamide, as adjuvant for malarial diagnostic applications in comparison with the available commercial antibodies. Methods: Two hybridoma clones (Aa3c10, b10c1) were used for the production of ascites in BALB/c mice. Purification of monoclonal antibodies from the ascites was carried out using affinity columns. The thermal stability study of monoclonal antibodies was done by storing it at 37°C and 45°C for thirty days. The stored antibodies were analyzed using SDS-PAGE and flow-through device where the antigenantibody interaction was visualized by Protein A colloidal gold solution. Sensitivity was determined by endpoint dilution ELISA and the dissociation constant by competitive ELISA. Sensitive pair optimization was done by sandwich ELISA using biotinylated antibodies. Prototype preparation for lateral flow assay had a colloidal gold-based detection system. Results: Thermal stability experiments showed that both mAbs (Aa3c10; b10c1) are stable up to thirty days at 45°C while the commercially available mAbs were stable up to fifteen days only. Compared to commercial antibodies, the mAb Aa3c10, showed the highest sensitivity in end-point titre. In sensitive pair optimization, it was observed that the mAb, b10c1, as a detector and the mAb, Aa3c10, as a capture antibody showed the highest absorbance to detect 50pg/ml PfHRP2 antigen. The prototype formulation of lateral flow assay using the mAbs (Aa3c10; b10c1) showed good reactivity with WHO panel and no false-positive results were observed with twenty clinically negative samples and five P. vivax positive samples. Conclusions: The novel monoclonal antibodies (Aa3c10, b10c1) against truncated PfHRP2, could be a strong potential candidates that can be included in making RDTs with better sensitivity and stability.

Sitagliptin induced acute severe nasopharyngitis.

Acute nasopharyngitis is one of the distressing adverse effects seen with the use of dipeptidyl peptidase-4 inhibitors like sitagliptin. Here, we report a case of acute severe nasophryngitis with the use of sitagliptin for diabetes mellitus.

Angiogenesis inhibitors in cancer therapeutics.

In the era molecular pharmacology, development of angiogenesis inhibitors is certainly a master discovery .There are specific angiogenesis inhibitors are being used in cancer and various endogenous anti-angiogenesis molecules are discovered .This review is a coverage of basic anti-angiogenic molecule like bevacizumab and other newer targets, after explaining the basic physiology of new vessel formation which helps in better understanding of these drugs.

Caries prevalence and treatment needs of rural school children in Chidambaram Taluk, Tamil Nadu, South India.

OBJECTIVE: To obtain information on caries prevalence and treatment needs of children aged 5-10 years to plan appropriate dental care services in rural areas. MATERIALS AND METHODS: Children studying in all the primary schools (six schools) in the field practice area of the Rural Health Centre of the Faculty of Medicine, Annamalai University, Chidambaram, were surveyed. Each child was clinically examined in the schools by calibrated examiners. Dental caries was assessed using diagnostic criteria recommended by WHO (1997). The chi-square test and two-way analysis of variance were used for statistical analysis. RESULTS: Five hundred and eight 5-10 year-old school children (247 boys and 261 girls) were surveyed. Caries prevalence was 71.7 and 26.5% in primary and permanent dentition, respectively. The mean dmft and decayed missing filled tooth (DMFT) scores were 3.00 and 0.42 respectively. The mean dmft decreased with age ( P < 0.01) whereas the mean DMFT increased with age ( P < 0.001). Although the mean dmft scores were not statistically significant different for the two sexes, the mean DMFT score was found to be higher among girls than among boys ( P < 0.02). The entire dmft/DMFT value represented the 'decay' component only. There was a strong need for single surface restorations (60.6%). In the WHO index age (5-6 years), the caries prevalence was 70.2% (29.8% caries-free) with a mean dmft value of 3.54 +/- 3.71. CONCLUSION: Dental caries is a significant public health problem in this population. An extensive system to provide primary oral health care has to be developed in the rural areas of India.

Reproductive tract infection in women of reproductive age group in Sitapur/Shahjahanpur District of Uttar Pradesh.

CARE India with its UP Office has initiated demand generation and acceptability of services for reproductive health and birth spacing services at community level in two districts in the state of Uttar Pradesh. A total of 3,49,000 women of reproductive age will benefit from participation in program activities over the next five years. Out of total surveyed population of 3662, 798 women of reproductive age group were identified of whom 272 were found to be symptomatically positive in relation of STDs/RTIs giving the overall prevalence rate of 34%. Clinical as well as the microbiological examination was carried out on 193 of these 272 women in field conditions. Those found clinically and/or microbiologically positive were provided treatment and preventive advice. Total of 150 (77.7%) women were diagnosed on the basis of symptoms (syndromic approach) and 151 (78.2%) were diagnosed on the basis of clinical examinations. However, 137 (70.9%) were confirmed microbiologically positive. A large extent was found in the age group of 15 to 24 years. Confirmed cases were comparatively less among nulliparous women (63.6%) than multipara (73.2%) cases. 64.1% women were having watery discharge while 29.1% were having complaint of curd discharge. The discharge was offensive in only 1.9% cases while 4.9% reported mixed discharge. 54.4% women complaining of vaginal discharge were suffering from PID. The discharge were either bacterial alone (26.1%) or bacterial mixed with candidiasis (16.5%) or trichomoniasis (8.7%). Compared to syndromic approach, an improvement in the sensitivity (81.8%) and predictive accuracy (74.1%) was noted when cases were detected with the help of clinical examination.

Relative prevalence of hepatitis B viral markers and hepatitis C virus antibodies (anti HCV) in Madurai, south India.

(1) The positivity of HBsAg was 4% (75/1819) whereas anti HCV was present only in 0.75% (27/3574) of blood donors. (2) 5.3% (4/75) of hospital staff had HBsAg alone in their blood samples. One doctor, one Staff nurse, one Lascar and one Sanitary worker were positive for HBsAg. None of them were positive for anti HBcIgm and anti-HCV. (3) 29% (31/115) of suspected hepatitis cases were positive for any one of the viral markers or both. 21% (15/72) of males and 14% (6/43) of females were positive for HBsAg. Whereas only 4% (3/72) of males and 2% (1/43) of females were positive for anti HCW. Both HBsAg and anti HCV were found in 8% (6/72) of males only. The age group predominantly, i.e. in 29 out of 31 cases found positive for HBsAg and/or anti HCV, was above 15 years. Two remaining HBsAg positive cases belonged to the 5 to 14 years age group. 71% (84/115) of suspected hepatitis cases were negative for both HBsAg and anti HCV.

Effect of myosin B on guinea pig muscles--light microscopic and immunological aspects.

Experimental myositis was induced in guinea pigs by multiple inoculations with Myosin B fraction of the rabbit skeletal muscle. Quantitative histopathological features were studied and they include necrosis, central nucleation, inflammatory cellular reaction. Besides myositis, features of myocarditis were evident in 40% animals. Circulating immune complexes (CICs) in the sera of experimental animals were isolated by a polyethylene glycol (PEG) precipitation method. Presence of antimyosin B antibody in the immune complexes was characterised by an enzyme-linked immunosorbent assay. The role of circulating immune complexes in pathogenesis of experimental myositis and human polymyositis have been emphasised.

Primary Ewing's sarcoma of the base of skull: a case report.

Primary cranial Ewing's sarcoma is an exceptionally rare lesion and only eleven cases have so far been reported. In this report we describe a case of primary Ewing's sarcoma arising from the floor of middle cranial fossa. Salient clinical, neuroradiological and light microscopic features in this case are described. A brief review of earlier published cases of primary cranial Ewing's sarcoma are also presented.

Epidermoid cyst of the brain stem--a case report.

Epidermoid cysts occurring within the brain stem are extremely rare and only nine such cases are reported in the literature. In this report, we report a case of Intrapontine epidermoid cyst in a young female patient.

Humoral immune reactions in tuberculous meningitis.

Humoral immune reactions as reflected in sera and cerebrospinal fluid (CSF) of 50 patients with Tuberculous meningitis (TBM) were studied. CSFs and sera from 50 patients with nontuberculous neurological diseases were selected as controls. CSFs of patients with TBM showed high titres of circulating antimycobacterial antibodies than in nontuberculous subjects. The CSF-IgG index is significantly higher in patients with TBM. Humoral immune reaction could be applied in the laboratory diagnosis of TBM, particularly when repeated bacteriological methods are negative for M. tuberculosis in CSFs.