“Endolymphatic sac tumour”: A case report with review of literature

Endolymphatic sac tumour (ELST) is a non-metastasizing low grade adenocarcinoma of endolymphatic sac origin. It is also known as Heffner tumour, low grade adenocarcinoma of endolymphatic sac origin and aggressive papillary middle ear tumour. These tumours are closely associated with Von Hippel Lindau (VHL) disease. Here we report a case of Endolymphatic sac tumour in a 63 yr old lady who presented with left sided facial palsy. Since the tumour was highly vascular and required preoperative embolization, initial clinicoradiological diagnosis was Jugulotymphanic paraganglioma. Histopathology showed features of Endolymphatic sac tumour, which was confirmed by immunohistochemistry. Since this tumour is locally aggressive low grade adenocarcinoma, the diagnosis is difficult in advanced cases where there is erosion of petrous temporal bone or the lesion shows extension into cerebellopontine angle as in our case. Since the association of this tumour with VHL disease is well established, it is important to screen all the patients of VHL disease for this lesion and also all the patients of ELST should be screened for other lesions of VHL disease to aid in early diagnosis and treatment. The case is presented here for its rarity and difficulty in initial diagnosis.

In vitro susceptibility pattern of Tigecycline against MRSA, ESBL producing Escherichia coli, Klebsiella species and Acinetobacter isolates in a rural tertiary care hospital.

Background: Tigecycline is the first commercially available glycycline, derivatives of the tetracycline antibiotics, having enhanced activity against various pathogens. In vitro activity has been demonstrated against multi drug resistant Gram positive and Gram negative pathogens like MRSA, ESBL producing Esch.coli and Klebsiella spp. and Acinetobacter Objective: To determine Tigecycline in vitro susceptibility pattern in MRSA, ESBL producing Esch.coli and Klebsiella spp. and Acinetobacter spp. Material and Methods: Investigations were carried out from August 2012-January 2014 to detect MRSA,ESBL producing Escherichia coli and Klebsiella spp. as well as Acinetobacter spp. by using a standard protocols and Tigecycline in-vitro susceptibility testing was done by Kirby Bauer Disc diffusion method and it’s MIC value against resistant isolates was evaluated.Statistical analysis was done by Fishers extract method. Result: Out of 107 Staphylococcus aureus isolates 52(48.59%) were MRSA, none of them showed resistance to Tigecycline. Out of 82 Esch.coli isolates 14 (i.e 17.07%) were ESBL producers, none of them showed resistance to Tigecycline.Out of 67 Klebsiella isolates 21 (i.e 31.34%) were ESBL producers out of which only 1 (i.e 4.76%) was resistant to Tigecycline.Out of 19 Acinetobacter spp.isolated 3 (i.e 15.78%) were resistant to Tigecycline. The MIC range for ESBL producing Eschcoli, Klebsiella spp., MRSA and acinetobacter spp were 0.14-0.45 μg/ml,0.25-2.4 μg/ml,0.12-0.26 μg/ml, 1-3.2 μg/ml respectively. Conclusion: The results of the study confirm the excellent in vitro activity of Tigecycline against Gram positive and Gram negative multidrug resistant pathogens.

Pharmacovigilance in kala-azar patients with severe thrombocytopenia caused by sodium antimony gluconate & miltefosine.

Sodium antimony gluconate (SAG) and miltefosine used in the treatment of kala-azar are known to cause several side effects but severe thrombocytopenia has not been reported. Four cases of severe thrombocytopenia, two caused by SAG and two by miltefosine were promptly detected and treated by immediate withdrawal of the offending drugs, platelet and blood transfusions and dexamethasone. After improvement Leishman-Donovan (LD) bodies were demonstrated in splenic aspirates of both patients of SAG group and one of miltefosine and they were treated with 1 mg/kg body wt of amphotericin B for 20 days and cured. One patient of miltefosine group treated outside only on the basis of rK-39 positivity did not show LD bodies in splenic aspirates and improved without any antikala- azar drug. None of the patients relapsed within 6 months of follow up. Prompt detection of side effects under the concept of pharmacovigilance can save life of such patients.

Enhanced stability and therapeutic utility of proteins upon conjugation with hydrophilic polymers.

The Pharmacological utility of various exogenous proteins is considerably impeded, since upon infusion, they are liable to rapid systemic clearance, proteolysis, in addition to eliciting severe immunological reactions. Upon conjugation with hydrophilic polymers like polyethylene glycol and dextran, the altered topology of proteins, often hinders interaction with their corresponding complementary surfaces. This is manifest in their increased circulatory-lives, as a fall out of decreased binding to proteases, pre-existing antibodies and other opsonins that mediate clearance by the reticuloendothelial-system as well as receptors mediating specific organ uptake. Further, an increase in conjugate size beyond the threshold limit of 70 kDa, permits small proteins to escape clearance via renal filtration. Upon covalent modification, proteins are generally endowed with an intrinsic inertness which is reflected in their enhanced stability in extremes of pH and temperature, presence of proteases and other denaturing conditions. The enhanced intracellular stability of conjugates which may also be responsible for their altered immunological properties is likely to be a consequence of the changed physiochemical properties of the conjugates. The therapeutic efficacy of these conjugates in clinical trials indicate their tremendous utility in pharmacological procedures.