Effect of inherited red cell defects on growth of Plasmodium falciparum: An in vitro study

Background & objectives: High prevalence of certain polymorphic alleles of erythrocytes in malaria endemic area has been linked to the resistance provided by these alleles against parasitic infestations. Numerous studies undertaken to demonstrate this correlation have generated conflicting results. This study was undertaken to investigate the abilities of various polymorphic erythrocytes to support in vitro growth of Plasmodium falciparum parasites. Methods: In this study under in vitro condition the ability of P. falciparum parasites to grow was assessed in the erythrocytes obtained from a total of 40 patients with various haemoglobinopathies, such as ?-thalassaemia (?-Thal), sickle cell anaemia, erythroenzymopathy-like glucose-6-phosphate dehydrogenase deficiency and membranopathy-like hereditary spherocytosis. Results: Significantly reduced in vitro invasion and growth of parasites was seen in the cultures containing abnormal erythrocytes than in control cultures containing normal erythrocytes (P< 0.05). The mean per cent parasitaemia comparison was also carried out among the three polymorphic erythrocyte groups, i.e. ?-Thal, sickle cell anaemia and enzyme-membranopathies. Interpretation & conclusions: Erythroenzymopathies and membranopathies were found to provide a more hostile environment for parasites, as the least parasitaemia was observed in these erythrocytes. The present in vitro study showed that P. falciparum did not grow well and did not invade well in erythrocytes obtained from common inherited red cell disorders.

Cytohistopathological Correlation in Palpable Breast Lesions.

The objective was to study the correlation between cytological and histopathological features and to find out the sensitivity and specificity of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of breast lesions. Two hundred patients were studied; 150 were retrospective and 50 were prospective cases. Only those patients who had FNAC followed by histopathological examination were included. Useful cytological parameters for diagnosis of malignancy were loss of cell cohesion, cell size, nuclear crowding and overlapping, nuclear size, type of chromatin, absence of bipolar naked nuclei and infiltration of stroma. In present study complete sensitivity was 96.2%, absolute sensitivity was 86.7%, predictive value was 100%, false negative were 1.9%. No false positive smear was seen. We concluded that a definitive diagnosis of malignancy by FNAC could be safely used for definitive treatment but the same was not true for non-malignant, suspicious or atypical smears. In these situations surgical biopsy was considered to be essential for definitive diagnosis.

Rosai Dorfman syndrome with extranodal manifestation.

Rosai Dorfman Syndrome (RDS) is a benign condition and a rare cause of cervical lymphadenopathy. It usually occurs in the first decade of life and manifest as massive enlargement of cervical lymph nodes. The disease has a benign course and involvement of the nasal cavity as an extranodal site is exceptional. A 22-year-old male presented as progressive massive bilateral cervical lymphadenopathy accompanied with nasal obstruction and occasional episodes of epistaxis. A FNAC from cervical lymph node and biopsy from nasal mass was compatible with RDS.

Immune status with empyema thoracis.

OBJECTIVE: To evaluate the humoral and cell mediated immune status of children with empyema thoracis. METHODS: Serum IgG, IgA, IgM, Complement C3 assay and cell mediated immunity (CMI) tests were performed in 33 patients of empyema thoracis, and 14 healthy age matched controls. RESULTS: The mean serum IgG and IgA levels in empyema thoracis and its subgroups were significantly raised as compared to controls. The overall values of IgG and IgA were 104% (p<0.001) and 114% (p<0.01) of normal mean, respectively. The mean serum IgM and complement C3 levels did not differ significantly in both the groups. The frequency of negative skin reaction to purified protein derivative (PPD) was significantly higher in children with empyema thoracis as compared to controls (p<0.05). The mean absolute lymphocyte count (ALC) was significantly decreased and serum adenosine deaminase (ADA) activity was significantly raised in empyema thoracis in comparison to controls. The overall ALC was 76.1% (p<0.01) and serum ADA activity was 169.4% (p<0.001) of normal mean, respectively. No significant differences were observed in the mean levels of immunoglobulins, complement C3 and CMI tests between pyothorax and pyopneumothorax and pleural fluid culture positive and negative cases. CONCLUSIONS: Thus, both humoral and cell mediated immunity were affected in empyema thoracis patients. However, CMI demonstrated more pronounced change in comparison to humoral immunity.

Post-Kala-Azar-dermal-leishmaniasis: an unusual presentation from Uttarachal (a non-endemic hilly region of India).

A 26-year-old male resident of Uttaranchal had a single large, erythematous, indurated verrucous plaque on chin of 1 year duration. He had suffered from visceral leishmaniasis 4-years back for which he was treated with injection sodium antimony gluconate (SAG) i.m. OD for 20 days. He had never been to regions endemic for kala-czar (KA) or post-kala-azar-dermal leishmaniasis (PKDL). Skin biopsy showed chronic granulomatous inflammation in the dermis. Giemsa stain revealed LD bodies inside the macrophages. The patient was treated successfully with injection SAG 20 mg/kg parenterally for 60 days. To the best of our knowledge, this is probably the first case of PKDL from the hills of Uttaranchal.

Mammary hamartomas--a report of 15 cases.

The mammary hamartoma is a poorly recognised benign breast neoplasm. For diagnosis one usually correlates the clinical, mammographic, gross and histologic features. This study of fifteen cases emphasises the histomorphologic criteria for diagnosis especially in the absence of mammographic picture, viz. a clinically palpable, well encapsulated mass which on histology shows normal breast epithelium admixed with fat, fibrous tissue and other mesenchymal elements. The epithelium in the hamartomas studied showed changes seen in normal breast especially in the progestational phase of the menstrual cycle. The stroma was either densely collagenous, hyalinised or cellular and admixed with fat in various proportion in thirteen cases, muscle in two cases and thick muscular arteries in four cases. It also showed pseudoangiomatous hyperplasia in seven cases. The importance of this change and probable evolution is discussed therein.

Synchronous oesophageal carcinoma with non Hodgkin's lymphoma, problems with management.

A case of synchronous malignancy of oesophagus with Non Hodgkin's lymphoma is presented and the rarity of such an association is discussed. The inherent difficulties encountered were initial planning of therapy keeping in view of the general condition of the patient. The patient received three cycles (every 21 days) of CHOP regimen for Non Hodgkin's lymphoma and to maintain a static state of oesophageal cancer. The patient showed more than 75 percent response to NHL counterpart, and for carcinoma oesophagus counterpart short course high dose loco-regional radiation therapy was given and the tumor was found to be resectable.

Dengue in Gujarat state, India during 1988 & 1989.

Following the reports of epidemics of febrile illness from several rural and urban areas of Gujarat state (India) in 1988, epidemiological investigations were carried out and dengue (DEN) virus activity was demonstrated in large cities such as Surat and Rajkot as well as several villages in Sabarkantha district. Two strains of dengue type-2 each were isolated from human sera from Surat city and a village in Sabarkantha district. Six strains of dengue virus were isolated from Aedes aegypti mosquitoes collected at Chotasan village, two of which were confirmed as DEN type-2. Of the 560 patients' sera tested from different areas (including villages and townships), 122 showed evidence of dengue infection and another 236 showed a broader reaction with flaviviruses. Entomological investigations showed a widespread distribution of Ae. aegypti both in urban and rural areas. In the household conditions this mosquito was found to breed predominantly in containers with non-potable water. Amongst these, cement containers manufactured in towns and distributed to the villages seem to play an important role in the spread of this species. In non-residential areas prolific breeding of Ae. aegypti was observed in automobile tyre dumps, and varied types of scrap, in towns and villages. Distribution and relative prevalence of the species were studied in 46 towns and villages, covering the spectrum of rural-urban-continuum. These studies provide an indication regarding the mechanism of the spread of DEN virus through peoples' movement, transport, the process of urbanisation etc.

Subclavian vein catheters for haemodialysis with and without a subcutaneous tunnel.

We have retrospectively analysed the usefulness of a subcutaneous tunnel in patients undergoing haemodialysis through a double lumen subclavian catheter; 194 catheters were used in 145 patients. In 105 patients a subcutaneous tunnel was created. Entry site infection was significantly higher in the no tunnel group (30%; P < 0.02). There was no statistically significant difference in the incidence of septicaemia in the two groups. Eighty five percent of episodes of septicaemia and 67% of entry site infections were due to Staphylococcus aureus. All responded to removal of the catheter and to antibiotics. The average duration the catheter was in place was 20.39 and 21.94 days in the groups with and without tunnel respectively. The average number of dialyses was 9.13 and 9.33 per catheter in the tunnel and no tunnel groups respectively. Three patients had pneumothorax. Subclavian vein thrombosis was suspected clinically in 3 cases. There was no catheter related mortality. We concluded that while entry site infection occurred more frequently in the no tunnel group, the overall incidence of septicaemia was not different in the two groups. Creation of a subcutaneous tunnel has no added advantage.

Serological profiles for HBV, HDV, HIV-1 and HTLV-1 in Saudi patients with a malignancy.

Serologic markers for HBV, HDV, HIV-1 and HTLV-1 were tested in 42 patients with a primary hepatocellular carcinoma (PHC); 19 with a malignancy of epithelial origin (EPM) and 16 with a non-epithelial malignancy (NEPM) in the Gizan Area of Saudi Arabia. HBV exposure in 77 PHC, EPM and NEPM patients was 92.2 per cent for any marker (overall) while 75.3 per cent positive for HBsAg. 3.9 per cent positive for anti-HBc and 12.9 per cent positive for anti-HBs. There was no inter PHC, EPM, NEPM or intersex variation for an individual marker or total HBV exposure. Among HBsAg-positives, 9 of the 12 PHC tested, 7 of the 10 EPM, 1 of the 9 NEPM were anti-D IgG positive. The HDV prevalence was the lowest in NEPM (p < 0.01). In patients with a malignancy, all HBV and HDV markers were higher than those of control population, even though anti-HBs was lower (p < 0.001). The probable contribution through different viruses in pathogenesis of malignancies of different types should be ascertained through polymerase chain reaction for viral components, oncogenes, etc. on tumourous biopsy tissues. The aggravation in PHC morbidity in HBV hyperendemic foci through HIV infection should be monitored through tests for unintegrated and integrated viral DNA in tumorous and non-tumorous tissues.

Short term study on relative merits of acetate and bicarbonate dialysis.

We did a double blind, crossover, prospective study comparing bicarbonate and acetate containing solutions in haemodialysis. Thirty stable patients with end stage renal disease on maintenance haemodialysis while awaiting a renal transplant were each studied on three dialysis with acetate and three with bicarbonate. Nine patients developed symptoms like headache, nausea, vomiting, giddiness, and malaise and developed hypotension during acetate dialysis and three patients during bicarbonate dialysis. There were symptoms during 16.66% of acetate dialysis sessions and 5.55% of bicarbonate dialysis sessions. (P less than 0.05). There was a statistically significant decrease in PaO2 and PaCO2 on acetate dialysis at 30 minutes after initiation of dialysis. There was no significant difference in weight loss on dialysis, or in blood pressure and correction of acidosis. We conclude that bicarbonate dialysis is better tolerated, but acetate intolerance is not a major problem since we use small surface area dialysers (0.8 M2).

Effect of corticosteroids on carbohydrate metabolism in Bufo melanostictus (Schneider).

A single injection of corticosterone (1 or 5 micrograms/50 g body weight) produced a significant elevation in plasma glucose, liver and muscle glycogen contents of B. melanostictus. Single but identical doses of aldosterone had no effect on plasma glucose concentration. Liver and muscle glycogen contents were however significantly augmented. Administration of 1 or 5 micrograms corticosterone and 1 microgram or 200 ng aldosterone/50 g body weight, for 15 days, caused no change in plasma glucose concentration. In all the groups receiving corticosterone or aldosterone for 15 days, liver and muscle glycogen contents significantly increased. The magnitude of increase in liver and muscle glycogen by aldosterone was marginally greater than that by corticosterone. The results suggest that both the corticosteroids may be gluconeogenic in B. melanostictus.

Iopanoic acid prevents spring premigratory increase in body weight of redheaded bunting Emberiza bruniceps.

Effects of long term administration of iopanoic acid (IOP), a potent inhibitor of peripheral conversion of thyroxine (T4) into triiodothyronine (T3), on body weight and gonad development in intact and in thyroidectomized (Thx) redheaded bunting that received replacement therapy with T4 were studied. IOP prevented the premigratory increase in body weight observed in intact bunting (during March/April). In contrast to the Thx birds receiving T4 only, IOP administration in combination with T4 caused a significant decrease in body weight of Thx birds. The gonad development in intact and Thx birds that received IOP was significantly inhibited. Results suggest that IOP through an effective inhibition of peripheral T4-monodeiodination may prevent the spring premigratory fattening. Emphasis is given for an important role of T3 in the physiological preparations associated with migration.