IgG4 related sclerosing encapsulating peritonitis with cocoon formation: An unusual and undescribed presentation

IgG4-related sclerosing mesenteritis is a rare disease of mesentery of an unknown etiology which shows a constellation of histopathologic findings of lymphoplasmacytic inflammation with IgG4-positive plasma cells and marked fibrosis. This chronic inflammatory condition of mesentery forming an abdominal cocoon has never been described before to the best of our knowledge. Here, we report a patient with a history of subacute small bowel obstruction who was found to have an intra-abdominal encapsulating mass in the right iliac fossa and was finally diagnosed as IgG4-related sclerosing encapsulating peritonitis (abdominal cocoon) based on peroperative findings, histology and immunohistochemistry.

Relationship of Body Mass Index, Waist Circumference and Waist-Stature Ratio with Body Fat of the Indian Gorkha Population

Introduction: Body mass index (BMI) has traditionally been the chosen indicator by which to measure body size, composition, and to diagnose underweight and overweight. However, alternative measures that reflect abdominal adiposity, such as waist circumference, waist–hip ratio and waist–height ratio, have been suggested as being superior to BMI in predicting cardio-vascular diseases (CVD) risk. This study was aimed at determining the predictive power of anthropometric indicators like body mass index, waist circumference and waist stature ratio with body fat in an Indian military personnel population group, and to establish cut-off points as discriminators of high body fat. Methods: The study was crosssectional in nature with a sample size of 388 active Gorkha male personnel aged 20-49 years (mean age 33.1±5.33). Anthropometric indicators included body mass index, waist circumference, waist-hip ratio and waist-stature ratio. The analysis of receiver operating characteristic curves (ROC) with a confidence interval of 95% was adopted to identify predictors of obesity. Subsequently, the cut-off points with their relevant sensitivities and specificities were identified. Result: Areas under the ROC curves with 95% confidence intervals were body mass index = 0.86 (0.84-0.88); waist circumference = 0.82 (0.80-0.84); waist- hip ratio = 0.74 (0.71-0.77); waist-stature ratio = 0.81 (0.78-0.84). Different cut-off points of anthropometric indicators with better predictive power and their relevant sensitivities and specificities were identified. The following cut-offs with their corresponding sensitivity and specificity values are suggested for determining obesity for the study population: body mass index= 23.4 (98.00, 62.00), waist circumference= 77.8 (98.00, 60.50) and waist stature ratio= 0.47 (98.60, 68.00) respectively. Conclusion: The results showed that among active military personnel, BMI, WC and WSR may serve well in classifying individuals into broad categories corresponding to percentage fat categories. Further studies on different populations should be undertaken for the verification of the cut-off levels identified.

Remediation of nitrite contamination in ground and surface waters using aquatic macrophytes.

The study was carried out to determine the seasonal variation of nitrite levels in drinking and surface waters of urban, peri-urban and rural areas of Lucknow, during 2007-2008, and to evaluate the nitrite removal and accumulation potential of certain native aquatic macrophytes. Most of the drinking and surface water samples were collected from urbanized region of the city. All drinking water samples detected, showed higher nitrite level in winter, when compared with that in summer and rainy seasons. However, in drinking water samples nitrite level was below the permissible limit i.e. 3.29 mg l-1 NO2. The surface water showed more than 3 fold higher levels of nitrite over the permissible level i.e. 0.06 mg l-1, and the level was higher during rainy season than in summer and winter seasons. Eight macrophytes viz. Peltandra virginica, Utricularia vulgaris, Eichhornia crassipes, Trapa natans, Mimulus glabratus, Marsilea quadrifolia, Pistia stratiotes and Polygonum persicaria were studied for phytoremediation potential of nitrite from the water under simulated laboratory conditions. The gradual diminution in the level of nitrite in the water and simultaneously it’s increase in the plant tissues was recorded at 5th, 10th and 15th d after plant culture. All the plants selected, removed nitrite from water but Polygonum persicaria, Mimulus glabratus, Trapa natans and Pistia stratiotes were found more efficient and removed nitrite upto 60.91, 58.09, 60.97 and 72.28%, respectively. Observations revealed that Pistia stratiotes can be used for the effective removal of nitrite from the contaminated water.

Anesthetic management of right atrial mass removal and pulmonary artery thrombectomy in a patient with primary antiphospholipid antibody syndrome.

Antiphospholipid antibody syndrome (APLAS) characterises a clinical condition of arterial and venous thrombosis associated with phospholipids directed antibodies. APLAS occurs in 2% of the general population. However, one study demonstrated that 7.1% of hospitalised patients were tested positive for at least one of the three anticardiolipin antibody idiotype. Antiphospholipid antibodies often inhibit phospholipids dependent coagulation in vitro and interfere with laboratory testing of hemostasis. Therefore, the management of anticoagulation during cardiopulmonary bypass can be quite challenging in these patients. Here, we present a case of right atrial mass removal and pulmonary thrombectomy in a patient of APLAS.

Evaluation of the polymerase chain reaction analysis for diagnosis of falciparum malaria in Delhi, India.

Plasmodium falciparum infections are frequently fatal if untreated and hence need to be diagnosed and treated early. Malaria diagnosis, with conventional Giemsa staining as a gold standard, has had several limitations. New rapid and accurate methods are needed for diagnosis. In this study, polymerase chain reaction (PCR) analysis specific for diagnosis of P. falciparum was evaluated. For the study, blood samples were collected from 310 patients suspected of having malaria. PCR analysis for P. falciparum from venous blood and at the same time Giemsa staining of thick and thin blood smears was done. A total of 160 (51.6 %) samples were positive for malarial parasite of which 63 (39.4 %) were positive for P. falciparum by Giemsa staining while 61 (38.1 %) were positive for P. falciparum by PCR analysis. Giemsa staining was time consuming, laborious and may give poor results in cases with low parasitaemia. The PCR analysis for P. falciparum was able to detect 3 cases of low parasitaemia missed initially on Giemsa staining, was 96.8 % sensitive, 100% specific but was very costly, needed a lot of practice and standardization and was time consuming. PCR analysis can be used to supplement the conventional Giemsa staining for reliable diagnosis of falciparum malaria especially in cases with low parasitaemia.

Magnetic resonance imaging in carcinoma cervix--does it have a prognostic relevance.

PURPOSE: To evaluate the prognostic relevance of tumor size as determined on Magnetic Resonance Imaging (MRI) in cervical cancer. METHODS AND MATERIALS: A total of 70 consecutive patients were included in the study. 15 patients underwent surgery alone (Group A), 27 patients underwent surgery followed by adjuvant radiation (Group B), 14 patients underwent concomitant chemo radiation (Group C), and 14 patients underwent radical radiation alone (Group D). External radiation was delivered followed by intra cavitary brachytherapy. Serial MRI scans were performed in all patients before and after completion of treatment on a 1.0 Tesla MRI scanner. Patients were divided into three groups based upon MR volumes 100 cc. A correlation between MR volume, FIGO stage, disease free survival (DFS) and overall survival (OS) was done. Disease free and overall survivals were calculated using Kaplan Meier survival curves according to stage, MR volume and treatment protocol. RESULTS: In group I (MR volume 100 cc), 57% patients had stage II, 14% had stage III and 29% patients had stage IV disease. The DFS and OS did not achieve a level of statistical significance when evaluated as per protocol [DFS at p = 0.0685 and OS p = 0.3242], however a statistical significance was seen when DFS and OS were evaluated according to MR volumes [DFS, p = 0.0015 and OS, p = 0.0001]. CONCLUSION: In cervical cancer, the volume of disease as assessed on MRI may be a better prognostic indicator than FIGO staging and needs further evaluation.

Evaluation of the direct acridine orange staining method and Q.B.C. test for diagnosis of malaria in Delhi, India.

Conventional Giemsa stained peripheral blood smear examination for demonstration of malarial parasites remains the gold standard for diagnosis of malaria in developing endemic countries. However this technique is time consuming, requires training and may give poor results in cases with low parasitaemia. To overcome these problems and improve diagnostic accuracy two newer tests have been studied and compared with standard Giemsa staining. These are the wet mount fluorescence microscopy of Acridine Orange stained thin blood films (A.O.) and the Quantitative Buffy Coat technique (Q.B.C) for diagnosis of malaria. A.O. staining was found to be 97.5% sensitive and 100% specific for detection of all stages and species of malarial parasite. The Q.B.C assay was found to be 100% sensitive and 97.5% specific for diagnosis of malaria. A.O. staining was very fast and the species identification was easy once the staining was optimised. The Q.B.C. test required considerable amount of practice, costly equipment, however it was fast and in our study was found to be highly sensitive.

Perforated peptic ulcer after cardiac surgery.

Although there are many causes of ulcer disease in postoperative period, hypoperfusion during cardiopulmonary bypass and advanced age are two key causes. We came across two cases of peptic ulcer perforation after coronary bypass graft surgery where these two common factors were absent. We have discussed various aetiolofical factors responsible for genesis of gastrointestinal ulcers in patients undergoing cardiac surgery using cardiopulmonary bypass.

Clinical profile and risk factors for oral candidosis in sick newborns.

OBJECTIVES: To provide the clinical profile and assess the significance of various risk factors contributing to the occurrence of oral candidosis in newborns. DESIGN: Case-control study. SETTING: Neonatal Intensive Care Unit (NICU). SUBJECTS: Twenty newborns with oral candidosis and an equal number of age and weight matched controls. INTERVENTIONS: All cases of oral candidosis were treated with local application of 1% Clotrimazole. RESULTS: Oral candidosis was documented in 3.2% (20/650) cases in the NICU. Acute pseudomembranous candidosis was the most common presentation. The mean age of onset was 10.5 days. Candida albicans was isolated in 50% cases in addition to C. tropicalis, C. paratropicalis, C. krusei, C. glabrata and C. parapsilosis. On univariate analysis, male sex, birth asphyxia and prolonged antibiotic therapy had a significant correlation with occurence of oral candidosis in neonates. Out of these, birth asphyxia was the only factor significantly associated with oral candidosis (OR 8.09, 95% CI 1.34-48.8, p = 0.0226) on multivariate analysis. CONCLUSIONS: C. albicans was the predominant isolate in this series of oral candidosis. Clinical manifestations were evident in the second week of life and birth asphyxia was the most important associated perinatal event.

In vitro effect of Phyllanthus amarus on hepatitis B virus.

To evaluate the effects of P. amarus on hepatitis B virus (HBV) antigens and HBV-DNA, initial ethanolic extract and subsequent fractions of the plants were prepared. The whole plant material was dried, powdered and extracted with alcohol and subsequently fractionated in hexane, chloroform, butanol and finally in water. All the material were tested for in vitro effects on HBsAg, HBeAg and HBV-DNA in serum samples positive for HBV antigens followed by the screening of respective antigens by Elisa. HBV-DNA was determined by molecular hybridization. The extracts were effective against HBV antigens, the butanol extract being the most potent. Further chromatographic fractions showed an enhanced activity. The active fractions inhibited the interaction between HBsAg/HBeAg and their corresponding antibodies suggesting anti-HBs, anti-HBe-like activity and also an effect on HBV-DNA.

Molecular cloning and restriction enzyme analysis of a long repetitive DNA sequence in rice.

Rice long repetitive DNA (9-20 kbp) reassociating at Cot 50 M.s was cloned in pBR325. Out of several recombinants (Camr Ampr Tets), only a few were selected randomly for further characterization. The insert size in all these clones was 3-4 kbp. Restriction enzyme analysis showed the absence of EcoRI and BclI sites, presence of a single PstI and PvuII site and multiple sites for AluI in 3 clones namely pRLl, pRL7 and pRL10. The BamHI-PstI fragment of about 0·4 kbp in the pRL7 insert DNA (pRL7-0·4 kbp) was subcloned in M13mpl8 and partially sequenced using Sanger’s dideoxynucleotide chain termination method. Dot matrix comparison of this sequence with rice rDNA sequences revealed low homology with the 25S rDNA sequence of rice, however, hybridisation did not indicate any homology.

In vitro studies on the effect of certain natural products against hepatitis B virus.

Picroliv (active principle from Picrorrhiza kurroa), its major components picroside I, catalpol, kutkoside I, kutkoside, andrographolide (active constituent of Andrographis paniculata), silymarin and Phyllanthus niruri extract were tested for the presence of anti hepatitis B virus surface antigen (anti HBs) like activity. HBsAg positive serum samples obtained from hepatitis B virus (HBV) associated acute and chronic liver diseases and healthy HBsAg carriers were used to evaluate the anti-HBs like activity of compounds/extract. The latter were mixed with serum samples and incubated at 37 degrees C overnight followed by HBsAg screening in the Elisa system. A promising anti-HBsAg like activity was noted in picroliv (and its major components) catalpol, P. niruri which differed from the classical viral neutralization. Picroliv also inhibited purified HBV antigens (HBsAg and HBsAg) prepared from healthy HBsAg carriers. The in vitro testing system appears to be a suitable model to identify an agent active against HBV, prior to undertaking detailed studies.