Morphological and molecular characterization of Aedes aegypti variant collected from Tamil Nadu, India

Background & objectives: Accurate mosquito species identification is the basis of entomological surveys and effective vector control. Mosquito identification is either done morphologically using diagnostic features mentioned in taxonomic keys or by molecular methods using cytochrome oxidase subunit 1 (coxI) and Internal transcribed spacer 2 (ITS2). Methods: We performed a larval survey for Aedes mosquitoes from eight different geographical regions in Tamil Nadu, India. The mosquitoes collected during the survey were characterized using both morphological and molecular markers. Results: During an entomological survey from eight different geographical regions in Southern India, a morphological variety named Aedes aegypti var. luciensis was observed. The variant mosquitoes were characterized using both morphological and molecular markers. The variant mosquitoes differed only in the dark scaling of 5th segment of hind-tarsi. Around one third to two third of the 5th segment in variant mosquitoes was dark which has been described as white in identification keys. No other significant difference was observed in adults or immature stages. The variation was heritable and coexisting in the field with the type form mosquitoes. Comparison of the genetic profile of coxI and ITS2 were similar in variant and the type form indicating both of them to be conspecific. Interpretation & conclusion: The morphological variant mosquitoes were found genetically similar to the Ae. aegypti type form. However, considering its high prevalence and coexistence with Ae. aegypti type form in different geographical regions, detailed studies on bionomics, ecology, genetics, behavior as well as its plausible role in disease transmission are warranted.

One-year clinical outcomes of different coronary drug eluting stents—Data from a prospective registry

We compared one-year clinical outcomes of different drug eluting stents (DES) used in a prospective observation registry maintained in two hospitals over three years. The primary endpoint was combination of all-cause mortality, stent thrombosis and revascularization. There was no significant difference among different DES. We grouped DES into well-evaluated Imported DES (Imported group), which used to be expensive prior to price control and economical Indian DES (Indigenous group) that lack supportive clinical trials. One-year follow-up data was available in 99% of Indigenous group (n=1856) and 98.5% of Imported group (n = 1539). After propensity score matching, there were 1310 matched pairs. There was no significant difference between two groups in the primary end-point or each of the components.

Plant profile, phytochemistry and pharmacology of Avartani (Helicteres isora Linn.)：A review

Plants are used as medicine since ancient time, in organized (Ayurveda, Unani & Siddha) and unorganized (folk, native & tribal) form. In these systems, drugs are described either in Sanskrit or vernacular languages. Avartani (Helicteres isora Linn.) is a medicinal plant which is used in several diseases. It is commonly known as Marodphali, Marorphali, Enthani etc. due to screw like appearance of its fruit. Avartani is used as a folk medicine to treat snake bite, diarrhoea and constipation of new born baby. In the research, antioxidant, hypolipidaemic, antibacterial and antiplasmid activities, cardiac antioxidant, antiperoxidative potency, brain-antioxidation potency, anticancer activity, antinociceptive activity, hepatoprotective activity, anti-diarrheal activity and wormicidal activity in this plant were reviewed.

Comparison of Alert-Verbal-Painful-Unresponsiveness Scale and the Glasgow Coma Score.

To determine how the AVPU (alert, verbal, painful, unresponsiveness) scale corresponds to Glasgow Coma Score (GCS), we compared the two scales. Two months to 12 years old patients were included in the study. The median GCS score (inter quartile range) for A/V/P/U were 14 (12-15), 11 (10-12), 6 (5.5-8) and 3 (3-4), respectively.

Validation of CRIB II for Prediction of Mortality in Premature Babies.

Objective: Validation of Clinical Risk Index for Babies (CRIB II) score in predicting the neonatal mortality in preterm neonates ≤32 weeks gestational age. Design: Prospective cohort study. Setting: Tertiary care neonatal unit. Subjects: 86 consecutively born preterm neonates with gestational age ≤32 weeks. Methods: The five variables related to CRIB II were recorded within the first hour of admission for data analysis. The receiver operating characteristics (ROC) curve was used to check the accuracy of the mortality prediction. H-L Goodness of fit test was used to see the discrepancy between observed and expected outcomes. Results: A total of 86 neonates (males 59.6%; mean birthweight: 1228± 398 grams; mean gestational age: 28.3 ± 2.4 weeks) were enrolled in the study, of which 17 (19.8%) left hospital against medical advice (LAMA) before reaching the study end point. Among 69 neonates completing the study, 24 (34.8%) had adverse outcome during hospital stay and 45 (65.2%) had favorable outcome. CRIB II correctly predicted adverse outcome in 90.3% (Hosmer–Lemeshow goodness-of-fit test P=0.6). Area under curve (AUC) for CRIB II was 0.9032. In intention to treat analysis with LAMA cases included as survivors, the mortality prediction was 87%. If these were included as having died then mortality prediction was 83.1%. Conclusion: The CRIB II score was found to be a good predictive instrument for mortality in preterm infants ≤32weeks gestation.

Cytoview: development of a cell modelling framework.

The biological cell, a natural self-contained unit of prime biological importance, is an enormously complex machine that can be understood at many levels. A higher-level perspective of the entire cell requires integration of various features into coherent, biologically meaningful descriptions. There are some efforts to model cells based on their genome, proteome or metabolome descriptions. However, there are no established methods as yet to describe cell morphologies, capture similarities and differences between different cells or between healthy and disease states. Here we report a framework to model various aspects of a cell and integrate knowledge encoded at different levels of abstraction, with cell morphologies at one end to atomic structures at the other. The different issues that have been addressed are ontologies, feature description and model building. The framework describes dotted representations and tree data structures to integrate diverse pieces of data and parametric models enabling size, shape and location descriptions. The framework serves as a first step in integrating different levels of data available for a biological cell and has the potential to lead to development of computational models in our pursuit to model cell structure and function, from which several applications can flow out.

Observational sickness assessment by the NICU staff nurses.

OBJECTIVE: To see the level of agreement on subjectively assessed sickness by NICU staff nurse with doctor. METHODS: Prospective study in NICU for three months. The nurses were asked to assess whether a baby is sick or not on the basis of observed physical variables. Both the nurses and the attending physician made their assessment on a progress sheet separately. Statistical analysis was carried out to see the agreement of the nurses with the doctors in respect to the sickness assessment, treatment, final outcome and the agreement between the symptoms picked up by the nurses and the doctors. RESULTS: Out of 112 babies admitted, 90 were observed to be sick by the nurses out of which 85 were observed to be sick by the doctors (Kappa=0.4098). Considerable accuracy was noted on comparing symptoms picked up by the nurses and the doctors'. The Kappa value for respiratory, GI and neurological system was 0.4278,0.401 and 0.59 respectively. A significant correlation was seen between the two groups with regard to the treatment given (p value=0.0456). CONCLUSION: Trained NICU staff nurse can identify sick neonate on observation.

Isolated Primary Tubercular Prostatic Abscess presenting as Pyrexia of unknown origin.

The genito-urinary tract is a common site of involvement in extra-pulmonary tuberculosis. However, an isolated tubercular abscess in the prostate with no evidence of disease elsewhere in the urinary tract is extremely uncommon unless the patient is immuno-compromised. We report an extremely rare instance of an isolated prostatic abscess presenting solely as pyrexia of unknown origin in a young male with no evidence of immuno-suppression.

Superimposed acute hepatitis E infection in patients with chronic liver disease.

BACKGROUND: The natural history of infection with hepatitis E virus (HEV) in patients with chronic liver disease (CLD) is not well described. Our study aims to document the presentation, course and outcome of HEV superinfection in patients with CLD. METHODS: Over an 18-month period, ten patients with CLD were diagnosed to have HEV superinfection by detection of anti-HEV IgM antibodies in a setting of acute worsening. These patients were tested for HBsAg, IgM anti-HBc, anti-hepatitis C virus antibodies and IgM anti-hepatitis A virus antibodies, and were followed-up. RESULTS: The etiology of underlying CLD in the 10 patients (9 men; mean [SD] age 42.4 [10.3] years) was alcohol in five patients, hepatitis B in two, hepatitis C in one and cryptogenic in two. Seven patients presented for the first time with recent-onset liver decompensation (median duration 27 days, range 7-45). All 10 had ascites and 7 had hepatic encephalopathy. Four patients developed renal failure during the course of illness. The median (range) bilirubin, ALT and albumin levels at presentation were 18.6 (4.9-32.6) mg/dL, 105 (28-6610) IU/L and 32 (29-41) g/L, respectively. At 8 weeks, only one patient had normalization of serum bilirubin or ALT levels. Three patients (30%) died, including two of renal failure and one of massive upper GI bleed. CONCLUSIONS: Superinfection with HEV in patients with CLD causes severe liver decompensation, which is frequently complicated with hepatic encephalopathy and renal failure. Acute hepatitis E in these patients has a protracted course with high morbidity and mortality.

Vascular tethering of the megaoesophagus by the azygos arch masquerading as a malignancy.

We report the case of a 50-year-old male, a known case of achalasia cardia for 15 years, who after being successfully treated earlier by pneumatic dilatation, presented with recurrent dysphagia due to vascular tethering of the megaoesophagus by the azygos arch simulating a malignant oesophageal stricture. The patient underwent oesophagectomy because of our inability to rule out the possibility of a malignancy developing in the mid-portion of the long-standing megaoesophagus. We wish to highlight the existence of this new clinical entity and the diagnostic as well as therapeutic dilemmas posed by it.

Colour Doppler flow imaging findings in portal biliopathy.

Biliary abnormalities in extrahepatic portal vein obstruction (EHPVO) have been described in detail on endoscopic retrograde cholangiopancreaticography (ERCP), but have never before been reported on colour Doppler flow imaging (CDFI). These changes occur either due to extrinsic compression of the bile ducts or due to ischaemic biliary stenosis. The aim of this study was to evaluate the role of CDFI in demonstrating the biliary changes in patients with EHPVO. Three out of 46 patients with EHPVO (7%), who presented clinically with obstructive jaundice, were subjected to a detailed CDFI study of the abdomen, followed by ERCP and splenoportovenography (SPV). One of the patients also underwent a repeat CDFI examination at 8 weeks following a lienorenal shunt. In all 3 cases, CDFI easily distinguished the anechoeic structures seen on ultrasound at the porta hepatis as periportal collaterals, the hepatic artery and dilated bile ducts. It revealed the actual indentation made on the common bile duct (CBD) by the collaterals besides showing the presence of biliary calculi. Gallbladder varices were also well demonstrated in all the cases. ERCP confirmed the presence of portal biliopathy besides showing other changes, such as angulation, displacement and stricture of the CBD. SPV confirmed the presence of EHPVO. One patient who underwent shunt surgery showed persistent dilatation of the CBD with calculi. CDFI is a rapid, non-invasive and widely available modality which can be used to demonstrate the biliary changes in patients with EHPVO with obstructive jaundice. It may thus help screen patients who require a further by ERCP examination for the planning of treatment.

Isolated tuberculosis of the pancreas: a report of two cases and review of the literature.

We report two cases of pancreatic tuberculosis. The first patent (who tested positive for HIV) presented with abdominal pain, fever, weight loss, anorexia and tender epigastric lump. The CT scan revealed multiple small abscesses in the pancreas. The second patients, who had no evidence of immunodeficiency, presented with constitutional symptoms and obstructive jaundice. The CT scan revealed a mass in the pancreatic head with peripancreatic lymph nodes and dilatation of the intrahepatic and extrahepatic biliary tree. None of the patients had Mycobacterium tuberculosis infection of the lung or any other organ. Fine-needle aspiration biopsy clinched the diagnosis in both the patients, with caseation necrosis and plenty of acid-fast bacilli in the first patient, and characteristic granulomatous inflammation of the pancreas in the other. The first patient died during the index hospitalization, while the other responded well to antitubercular treatment with improvement in symptoms and radiological clearance of the initial lesions.

Surgical management of obstructive gastroduodenal tuberculosis.

BACKGROUND: Gastroduodenal tuberculosis is a rare but potentially curable condition. The aim of the present study was to evaluate the clinical presentation, pre-operative status, management and outcome in patients with histologically proven diagnosis of gastroduodenal obstruction due to tuberculosis. METHODS: We retrospectively reviewed the records of 17 patients managed surgically for gastroduodenal obstruction due to tuberculosis. RESULTS: The site of obstruction was the pyloroduodenal canal in 53% of patients, second part of the duodenum in 24%, third part of the duodenum in 12% and duodenjojejunal flexure in 12%. The obstruction was caused by fibrotic stricture formation in 59% of patients and extrinsic compression by a lymph nodal mass in 41%. Endoscopic biopsy was diagnostic in only 29% of the patients in whom it was performed. Overall, a pre-operative diagnosis of gastroduodenal tuberculosis was suspected in only 35% of patients. All the patients underwent surgical drainage procedures and the diagnosis was confirmed by histopathological examination of biopsies taken at the time of laparotomy. CONCLUSIONS: In view of its rarity and non-specific findings on clinical, radiological and endoscopic evaluation, tuberculosis as a cause of gastroduodenal obstruction is seldom diagnosed pre-operatively. Hence, a high index of suspicion is required in young patients residing in endemic areas. Surgical intervention helps not only in relieving obstruction but also in confirming the diagnosis.

Long QT syndrome manifesting as pulseless epilepsy.

A-10-year-old child admitted with repeated seizures due to the long QT syndrome is described. The cardiac origin of the epilepsy was suggested by the fact that during the episode of convulsions his peripheral pulses were not palpable.

The clinical risk index of babies (CRIB) score in India.

OBJECTIVE: To assess the usefulness of clinical risk index of babies (CRIB score) in predicting neonatal mortality in extremely preterm neonates, compared to birth weight and gestation. METHODS: 97 preterm neonates with gestational age less than 31 weeks or birth weight less than or equal to 1500 g were enrolled for the prospective longitudinal study. Relevant neonatal data was recorded. Blood gas analysis results and the maximum and the minimum FiO2 required by babies in first 12 hours of life were noted. Mortality was taken as death while the baby was in nursery. The prediction of mortality by birth weight, gestational age and CRIB score was done using the Logistic model, and expressed as area under the ROC curve. RESULTS: The area under the ROC curve for birth weight, gestational age and CRIB score was almost the same, the areas being 0.829, 0.819 and 0.823 respectively. Hence CRIB score did not fare better than birth weight and gestational age in predicting neonatal mortality. CONCLUSION: The CRIB score did not improve on the ability of birth weight and gestational age to predict neonatal mortality in the study.