Gastrointestinal tract involvement in patients with potential celiac disease beyond the small intestine: An early proof with IgA anti-tissue transglutaminase-2 antibody deposits

Background: IgA anti-tissue transglutaminase-2 antibody (anti-TG2Ab) deposits in intestinal and extraintestinal organs have been used to link the respective pathological changes in these organs with celiac disease (CeD). Aims: To know if parts of intestine other than the duodenum, such as esophagus, stomach, and colon, have any pathology related to potential CeD or have mucosal IgA anti-TG2 Ab deposits. Settings and Design: A prospective case–control study conducted from April 2018 to December 2019. Materials and Methods: Nine patients with potential CeD and 27 age- and gender-matched patients with irritable bowel syndrome were recruited as cases and controls, respectively. Mucosal biopsies were collected from esophagus, stomach, duodenum, and rectosigmoid regions, histological changes were evaluated, and IgA anti-TG2 Ab deposits were analyzed in these regions by two-color immunohistochemical staining. Statistics: Data were analyzed using statistical software Stata 14.0. Results: No distinct difference in mucosal lymphocytosis were identified between biopsies of patients with potential CeD and controls at the following sites: esophagus (11.1% vs 0%, P = 0.079), stomach (14.3% vs 7.7%, P = 0.590), and rectum (20% vs 0%, P = 0.067). Co-localized IgA anti-TG2Ab deposits were observed more in potential CeD than in controls at esophagus 22.2% (2/9) vs 0%, P = 0.012; stomach 66.7% (6/9) vs 11.5% (3/26), P < 0.001; and duodenum 66.7% (6/9) vs 0%, P < 0.001 but not at rectum 0% (0/4) vs 0% (0/25). Conclusion: Although histological changes are not distinct, a subset of subjects with potential CeD has pan-intestinal involvement other than in the duodenum.

Social Determinants and Risk Factors Associated with Multi-Drug Resistant Tuberculosis Among Tuberculosis Patients in Tamilnadu – A Case-Control Study

Introduction: The emergence of Multi-drug Resistant Tuberculosis (MDR- TB) is a challenge for global control and prevention mainly in developing countries. The objective of the study was to identify inde-pendent risk factors for the occurrence of MDR-TB. Methods: An unmatched Case-control study was conducted among tuberculosis patients registered un-der NTEP in Kanchipuram district. ‘Cases’ were consecutive MDR TB patients aged 15 and older. ‘Con-trols’ were patients aged 15 and older, diagnosed with drug susceptible TB. Data was collected using pretested semi-structured questionnaire with face-to- face interview. Univariate and multi-variate anal-ysis were used to identify associated determinants of MDR-TB. Results: A total of 80 subjects, 20 cases and 60 controls (1:3) were recruited. Mean age of ‘cases’ was 32±9.3 years, and for controls was 31± 8.3 years. Multiple logistic regression analysis identified five sig-nificant risk factors such as passive smoking [OR = 8.449, 95% CI (6.791–30.27)], overcrowding [OR= 2.062,95% CI (1.004-3.005)], low socio-economic status [OR=8.000,95% CI (2.362-27.099)] and previ-ous TB treatment [OR =13.72 with 95% CI (8.599-35.118)]. Inadequate ventilation [OR=4.643(4.217-13.906)] Conclusion: To reduce the burden of drug-resistance, these risk factors can be used as screening tool in identifying individuals with MDR-TB in resource limited settings.

Small cell variant anaplastic large cell lymphoma presenting as leukemia: A case report and review of Literature

Anaplastic large cell lymphoma (ALCL) is a subcategory of the mature T-cell neoplasm characterized by sheets of cluster of differentiation (CD)30-positive pleomorphic large cells mostly present as lymphadenopathy. Here, we describe a case of Small cell variant ALCL with leukemic presentation without lymphadenopathy. A 68-year-old male presented with fatigue and weakness; examination revealed a total leukocyte count of 295,000/uL. The peripheral smear showed cells having cerebriform nuclei comprising 90% of the leukocytes. The flow cytometry showed that the cells were immunopositive for CD3 (weak), CD4, CD7, and negative for the rest of the markers. The cell blocks from the peripheral blood showed cells with immunopositivity for CD30, anaplastic lymphoma kinase (ALK), and Epithelial membrane antigen (EMA). A diagnosis of the small cell variant of ALK-positive ALCL was made. Due to the presence of atypical pleomorphic cells without lymphadenopathy, the case has a diagnostic dilemma with differential diagnosis of Sezary syndrome, T-cell prolymphocytic leukemia, and adult T-cell leukemia/lymphoma. Karyotyping and additional immunohistochemistry help for the confirmation of the diagnosis.

Genetic distance and phylogenetic studies of two Indian snakehead and one carp fish species

Aim: To study genetic distance and phylogenetic relationship of two different stock of three important fish species, i.e., Channa stewartii, C. striatus and Labeo gonius of Assam. Methodology: Three fish species, namely Channa stewartii, C. striatus and Labeo gonius were collected from two beels, i.e., Thekera and Samaguri beels of Assam, India. Standard procedures were followed for isolation of their DNA and sequencing. Thereafter, genetic distance and diversity and phylogenetic studies of three species were calculated using computer based softwares ClustalW and MEGA6. Results: In the present study, the pairwise genetic distance of three fish species ranged from 0 to 20.436. No pairwise distance was found between two stocks at different locations Thekera and Samaguri beels of Assam for each of three species C. stewartii, C. striatus and L. gonius. The highest values (20.436) of pairwise distance were found between C. striatus and L. gonius population of Thekera beel; Thekera and Samaguri beels; and L. gonius population of the Thekera and Samaguri beels. The overall average distance for the two populations of three fish species was 15.387. No significant intraspecific difference was observed in the phylogenetic studies of two stocks of three fish species. Interpretation: The overall average distance (15.387) of three fish species could be attributed to genetic distance from each other. The high value of coefficient of differentiation (1.000) for three fish species from two stocks indicated that all the species were different from each other. Overall genetic and phylogenetic studies revealed that C. stewartii, C. striatus and L. gonius. were less differentiated from each other.

Bimanual 25-gauge chandelier technique for direct perfluorocarbon liquid-silicone oil exchange in retinal detachments associated with giant retinal tear

Direct perfluorocarbon liquid (PFCL)-silicone oil exchange presents its own set of challenges in the micro incision vitreous surgery era. We propose a simple bimanual technique to circumvent this problem. Thirteen eyes of patients with retinal detachment associated with giant retinal tears underwent vitrectomy followed by self-retaining endo illuminator (Chandelier) assisted direct PFCL-silicone exchange. No intra or postoperative complications related to the surgical technique were noted. All patients had attached retinas and satisfactory visual recovery at 6 months. Direct bimanual PFCL silicone oil exchange using a Chandelier seems to be a safe and effective technique.

Inflammatory markers in meconium induced lung injury in neonates and effect of steroids on their levels: a randomized controlled trial.

PURPOSE: To determine the levels of TNFa and IL-1beta in tracheal aspirates of neonates with meconium aspiration syndrome (MAS) and to ascertain whether the use of steroids by systemic or nebulized routes suppresses the levels of these inflammatory markers. METHODS: This was a double blind, randomized, controlled, prospective, interventional study done over one year period in the neonatal unit of the Lady Hardinge Medical College. Fifty-one babies of MAS which were randomly distributed into three groups; control, systemic and nebulized steroids; were included in the study. Methyl prednisolone was given intravenously in the dosage of 0.5 mg/kg/day in two divided doses while nebulized budecort was given in a dosage of 50 mcg/dose twice daily. Tracheal aspirates were taken on day 1, 3 and 4 and were analyzed for TNFa and IL-1b by ELISA technique. RESULTS: TNFa in tracheal aspirates showed an increasing trend in babies of MAS in first four days, thereby signifying an inflammatory process underlying the condition. The levels of TNFa were suppressed by use of steroids. Higher levels of TNFa were associated with longer stay in hospital. IL-1b did not show any significant correlation. CONCLUSIONS: TNFa is associated with meconium-associated inflammation. Its level is suppressed with the use of steroids and can also be used to assess prognosis of neonates with MAS.

Coccidioidomycosis presenting as liver abscess.

A 26-year-old man presented with pain in the right upper abdomen. Ultrasonography revealed a large solitary right lobe liver abscess, which was treated by aspiration and antiamebic treatment. The patient continued to be symptomatic with the abscess increasing in size. Repeat aspiration revealed a pure growth of coccidioidomycosis, which was confirmed on culture. He was treated with amphotericin-B; the abscess resolved completely and the patient has remained asymptomatic at one-year follow up.

Genetic variation at minisatellite loci D1S7, D4S139, D5S110 and D17S79 among three population groups of eastern India.

Genetic variation at four minisatellite loci D1S7, D4S139, D5S110 and D17S79 in three predominant population groups of eastern India, namely Brahmin, Kayastha and Garo, are reported in this study. The Brahmin and Kayastha are of Indo-Caucasoid origin while the Garo community represents the Indo-Mongoloid ethnic group. The methodology employed comprised generation of HaeIII-restricted fragments of isolated DNA, Southern blotting, and hybridization using chemiluminescent probes MS1, pH30, LH1 and V1 for the four loci. All four loci were highly polymorphic in the population groups. Heterozygosity values for the four loci ranged between 0.68 and 0.95. Neither departure from Hardy Weinberg expectations nor evidence of any association across alleles among the selected loci was observed. The gene differentiation value among the loci is moderate (GST = 0.027). A neighbour-joining tree constructed on the basis of the generated data shows very low genetic distance between the Brahmin and Kayastha communities in relation to the Garo. Our results based on genetic distance analysis are consistent with results of earlier studies based on serological markers and linguistic as well as morphological affiliations of these populations and their Indo-Caucasoid and Indo-Mongoloid origin. The minisatellite loci studied here were found to be not only useful in showing significant genetic variation between the populations but also to be suitable for human identity testing among eastern Indian populations.

Immunogenicity and tolerance of H. influenzae type b, tetanus toxoid conjugate vaccine given concurrently or in combination.

The present prospective, open, controlled, randomised comparative trial was undertaken to evaluate the sero response and side effects of PRP-T Conjugate Vaccine (ACT-HIB) in infants and children aged 2 months and 16-24 months. Fifty four babies aged 2 months formed group A, 56 children aged 16-24 months formed group B. Groups A and B were further subdivided into two sub groups each destined to receive either PRP-T vaccine in association with DPT vaccine at different sites (I) or PRP-T and DPT both vaccines at the same site mixed in the same syringe (II). Group A received 3 doses at 2, 3 and 4 months of age and group B received one dose between 16-24 months. The Geometric mean titres of Anti PRP antibodies observed in primary immunisation schedule (A) and single dose vaccination schedule (B) were comparable and significantly higher to prevaccination titres. A serum anti PRP level of > 1.0 mcg/ml after immunisation is believed to correlate with long term protection. Ninety-six percent of infants in Group A and 98% in Group B achieved titres > 1.0 mcg/ml. The side effects were minimal, local and were comparable between the study and control groups, suggesting that PRP-T vaccine is highly immunogenic and well tolerated in Indian infants and children.

Fatal pulmonary infection caused by Mycobacterium smegmetis in an infant.

Mycobacterium smegmetis is a rapidly growing mycobacteria which is usually regarded as an environmental saorophyte. Recently it has been isolated from human beings mainly from skin and soft tissue lesions. Pulmonary lesions are extremely rare. A case of pulmonary consolidation caused by M. smegmetis in an infant is reported. The outcome was fatal. The organism was resistant to various antitubercular drugs. A brief review is presented.

Detection of beta-thalassaemia mutations in eastern Indian population by polymerase chain reaction.

We report here the application of a non-radioactive amplification refractory mutation system (ARMS) for the direct detection of beta-thalassaemia using polymerase chain reaction. Seven beta-thalassaemia mutations accounting for 89 per cent (71 of 80) of the alleles in eastern Indian population have been identified and majority (67.5%) were due to IVS-1 nt 5 (G-C) mutation. Interestingly, 9 cases did not reveal any of the 17 common mutations reported so far from Indian population.

Paddy field dermatitis in Assam: a cercarial dermatitis.

Rice field dermatitis is an occupational health problem in Assam. The afflicted paddy field workers develop exanthema on the exposed parts of their skin mainly legs and arms when they come in contact with water in rice fields. Itching sensations start after 30 minutes to 1 1/2 hours after initial exposure. After 6-12 hours there is intensely pruritic macular eruption and in a few cases secondary skin infection may also develop. The clinical course of the disease is suggestive of cercarial dermatitis. Numerous gastropod snails belonging to families Lymnaeidae, Bulinidae and Planorbidae were collected from paddy fields and were investigated for cercarial infection. It was found that planorbid snails were infected with animal schistosome cercariae. These cercariae were able to invade human skin and caused dermatitis in human volunteers after repeated exposure.

Observations on the breeding habitats of Aedes aegypti in Calcutta following an episode of dengue haemorrhagic fever.

A year-long (Nov. 1990-Oct. 1991) search for Ae. aegypti larvae was made of all water containers in and around fixed 100 houses at Bowbazar area in Calcutta following an episode of DHF. Out of 10151 containers searched, 615 (6%) were positive. Masonry tanks were the major (64.2%) and preferred (17%) breeding sites of Ae. aegypti. Indoor containers (6.7%) were more conducive to breeding of the vector species than the outdoor ones (3%). Breteau index showing wide variation (25 in December '90 to '93 in August 1991) proved to be the best for measurement of density of larval population of Ae. aegypti and paralleled the fluctuation in both rainfall and humidity. Role of temperature was not pronounced. It was noted that cases of DHF occurred even with the lowest Breteau index in December.