HLA- B*5701 Allele in HIV-infected Indian Children and its Association with Abacavir Hypersensitivit

Objective: To determine the prevalence of HLA-B*5701 allele in HIV-infected children, andtofind its associationwith Abacavir hypersensitivity. Methods: Children (2 to 18 y) already on,or to be initiated on Abacavir were included for PCR sequencing to detect HLA-B*5701.Outcome measures were: proportion with HLA B*5701 allele and hypersensitivity withAbacavir. Abacavir was stopped if patient tested positive for HLA-B*5701 allele. Results:100 children(median age 11 y) were enrolled; 10 were already on Abacavir. HLA-B*5701positivity was observed in 11 (11%) children. Two of these 11 children developedhypersensitivity after initiation of Abacavir. Abacavir was thereafter stopped in all whotested HLA-B*5701 positive, irrespective of the development of hypersensitivity reaction.Conclusion: HLA-B*5701 allele was present in 11 (11%) of HIV-infected children,of whichtwo developed Abacavir hypersensitivity. None of the patients without the allele developedhypersensitivity.

A study of triple negative breast carcinomas.

Aim and objectives: To show the incidence of triple negative breast carcinomas in the younger age group (20-40 years) in the study sample and to establish a correlation between expression patterns of estrogen receptor (ER), progesterone receptor (PR) and HER2 /neu with tumour histopathology of breast carcinoma. Material and methods: A 5 years study, 2 years restopective and 3 years prospective was conducted in Mahatama Gandhi Memorial hospital, Warangal, from 2009 to 2014 on triple negative breast carcinomas. All the mastectomy specimens, received in the pathology Department during this period were considered. Results: Total of 28 cases of carcinoma breast in females diagnosed histopathologically, were included in the study. In the present study, the patients were in the age group of 20-40 years Since most carcinomaS in this age group are triple negative. most of the tumours werte of size > 5 cm, 12 cases (43%), followed by 10 cases (36%) of size 2-5 cm. Total 20 (71.4%) were IDC (NOS), followed by 4 (14.2%) were Medullary carcinomas and 2 (7.1%) cases of ILC and each 1 (3.6%) case of tubular and Mucinous carcinomas. Histopathological grading was done according to Modified Bloom Richardson grading and found that 11 (39.3%) were of grade II followed by 5 (17.9%) cases were grede lll,4 cases were of grade I and 8 cases were inassessible. ER and PR were positive in 61% and 47% of tumors respectively. HER-2 over expression was seen in 36% of tumors and was negative in 64% of tumours. Triple negative carcinomas were 4 out of 28 cases, of which 3 were IDC (NOS) and 1 was medullary carcinoma. Triple negative carcinomas are associated with poor prognosis. Conclusion: ER, PR and HER-2 status correlates well with histopathological grading and other clinico-pathological parameters. Higher grade is associated with HER-2 positivity and ER/PR negativity,larger tumor size, lympho-vascular invasion, lymph node metastasis, and higher clinical stage.

A comparative study between conventional system and the Bethesda system applied for reporting thyroid cytopathology.

Aim and objectives: To compare the conventional and the Bethesda system for reporting thyroid cytopathology (TBSRTC), to correlate the cases with histology wherever available and to determine the sensitivity, specificity and false positive rates of both the methods. Material and methods: A Total of 240 patients who presented with thyroid gland swelling were subjected to thyroid fine needle aspiration cytology (FNAC) and the smears were made followed by H&E staining and reporting was done The convential system used at our centre includes description of microscopic findings of the case along with an impression at the end. The categorization according to the Bethesda system of reporting thyroid cytology were done using criteria published in the atlas and related literature. The cytological diagnosis was correlated with the histological diagnosis wherever it was available. The sensitivity, specificity, false positive rates were calculated considering cytology as screening test for differentiating between neoplastic and non-neoplastic lesions. Results: When the results of the conventional system were compared with the Bethesda adapted method was found to be more superior. Sensitivity of Bethesda system was significantly high (100%) as compared to conventional system (77%). Specificity of Bethesda system was also significantly high (82.5%) as compared to conventional system (69%). Conclusion: Our findings were consistent with others who used the Bethesda cytopathology reporting system.

Hepatoprotective activity of methanolic leaves extract of Rostellularia procumbens by using carbon tetrachloride intoxicated rats.

Background: Rostelluria procumbens is a medicinal plant used traditionally in the treatment of asthma, cough and constipation and as an antioxidant etc. it is rich in phytochemical compounds, which are responsible for its biological properties. The present study focused on evaluation of hepatoprotective activity of methanolic extract of R. procumbens leaf in carbon tetrachloride (CCl4) induced hepatotoxocity in rats. Methods: In this study, 30 wistar rats were used and grouped into 6 each group contain 6 rats. In this study, CCl4 is used as hepatotoxin. Four groups were treated with CCl4 and taken as disease control, standard, and two test groups. One group was taken as control treated with saline. Blood samples were collected and estimated serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, alkaline phosphatase and total bilirubin, which are key markers of liver function. The rats were sacrificed and livers were isolated and histopatological studies carried out. Results: On oral administration of methanolic leaves extract of R. procumbens to ethanol intoxicated, rats resulted in significant restoration of enzyme levels and also silymarin at a dose of 25 mg/kg. The reversal of increased serum enzymes in ethanol-induced liver damage by the extract may be due to the prevention of leakage of intracellular enzymes by its membrane stabilizing activity. Conclusion: The results confirm that R. procumbens have hepatoprotective activity against CCl4 induced hepatotoxicity and significant hepatoprotection seen at 500 mg/kg dose.

Paediatric HIV - trends & challenges.

With the availability of antiretroviral therapy (ART), HIV infection, which was once considered a progressively fatal illness, has now become a chronic treatable condition in children, as in adults. However, the challenges these children are forced to face are far more daunting. The most significant shortcoming in the response to paediatric HIV remains the woefully inadequate prevention of motherto- child transmission (PMTCT), allowing a large number of children to be born with HIV in the first place, in spite of it being largely preventable. In the west, mother-to-child transmission has been virtually eliminated; however, in resource-limited settings where >95 per cent of all vertical transmissions take place, still an infected infants continue to be born. There are several barriers to efficient management: delayed infant diagnosis, lack of appropriate paediatric formulations, lack of skilled health personnel, etc. Poorly developed immunity allows greater dissemination throughout various organs. There is an increased frequency of malnutrition and infections that may be more persistent, severe and less responsive to treatment. In addition, these growing children are left with inescapable challenges of facing not only lifelong adherence with complex treatment regimens, but also enormous psychosocial, mental and neuro-cognitive issues. These unique challenges must be recognized and understood in order to provide appropriate holistic management enabling them to become productive citizens of tomorrow. To address these multi-factorial issues, there is an urgent need for a concerted, sustainable and multipronged national and global response.

Vertical Transmission of HIV-An Update.

One of the greatest successes in AIDS research to date has by far been the discovery of successful interventions that interrupt the transmission of HIV from mother to child. It is however important to note that these successes have occurred largely in countries with great resources and the least burden of perinatal transmission of HIV. In the developing world wherein currently 95% of vertical transmission of HIV occurs, it is highly condemnable that still every minute an infected infant is said to be born in spite of the fact that vertical transmission is largely preventable, mainly because translating knowledge into practice is not always possible or feasible; This has led to a continuous growing numbers of children with HIV, thereby making pediatric HIV a looming problem rapidly draining the already burdened health care system of these countries. It is the need of the hour to appropriately address the challenges to achieve zero percent transmission of HIV from an infected mother to her child thereby giving a hope for an AIDS-free new generation worldwide.

Prevention of mother-to-child transmission of HIV--an overview.

With the human immunodeficiency virus (HIV) epidemic showing a shift towards women and young people, the increasing seroprevalence among women will result in an increase in the mother-to-child transmission of HIV. The vast majority of HIV-positive children worldwide acquire the infection through vertical transmission. The discovery of successful interventions that interrupt this transmission has been one of the greatest successes in AIDS research. The transmission of HIV from an infected mother to her child can be reduced to less than 2 peer cent by intensive interventions in the antenatal, intranatal and postnatal periods. To achieve this low rate, primary prevention of HIV infection in parents-to-be, early identification of seropositivity in pregnant women, prevention of unwanted pregnancies, prevention of mother-to-child transmission of HIV by appropriate antiretroviral therapy, special interventions in maternal management during labour, appropriate care and follow up of the newborn, all play an important role. However, these approaches are not always possible in developing countries wherein currently 95 per cent of vertical transmission occurs. Several questions and challenges remain. These include choice, availability, affordability, duration, long-term safety of optimal antiretroviral agents to be used during pregnancy and early neonatal life and the issue of transmission via breastfeeds in situations where alternatives to breastfeeding are not available. The challenge is to find the most cost-effective and feasible intervention to achieve zero per cent transmission of HIV from an infected mother to her child.