Liver Function Profile Anomalies in HIV Seropositive Tuberculosis.

BACKGROUND: The Human Immunodeficiency Virus (HIV) and the Tuberculosis (TB) co infection are contributory to each other in causing a progressive decline in the cell mediated immunity and a damage to the hepatobiliary system. The aim of our study was to estimate the extent of liver damage which was caused by these infections before the start of the therapy with hepatotoxic drugs like Antiretroviral Therapy (ART) and Antitubercular Drugs (ATD). METHODS: One hundred and ninty three confirmed HIV positive cases were enrolled in this study. The cases were divided into 2 groups; Group 1-100 subjects with TB and Group 2-93 subjects without TB.80 age and sex matched controls were also included (Group 0). Some parameters of the serum Liver Function Test (LFT) were estimated biochemically by using an auto analyzer (ERBA XL600,Transasia). RESULTS: The serum total bilirubin, Alanine Transaminase (ALT), Aspartate Transaminase (AST) and the Alkaline Phosphatase (ALK-P) levels were significantly higher in the cases as compared to those in the controls, more so in the cases with the associated TB co infection, except the AST levels. The Group 1subjects had lower serum total protein and albumin levels and altered albumin/globulin ratios as compared to the controls. A statistically significant difference was absent in the serum total protein levels between the Group 2 cases and the Group 0 controls. No significant differences were observed when the values for serum total protein, albumin and globulin and the albumin: globulin ratios among the two case groups (1 and 2) were compared. CONCLUSION: The results have shown the importance of estimating some LFT parameters, prior to the start of ATD and ART in these cases. Hence, a mandatory performance of LFT is recommended, as it is simple and cost effective.

Diagnostic Role of Tumour Markers CEA, CA15-3, CA19-9 and CA125 in Lung Cancer.

The aim of this study was to assess the diagnostic yield of the tumour markers carcinoembryonic antigen, carbohydrate antigen 15-3, carbohydrate antigen 19-9 and carbohydrate antigen 125, in serum and bronchoalveolar lavage fluid in a group of patients with bronchogenic carcinoma. Serum and bronchoalveolar lavage fluid samples were collected in a group of 90 patients with benign or malignant pulmonary diseases. After appropriate processing, tumour markers were determined by enzyme immunoassay. The diagnostic yields (sensitivity, specificity and predictive values) in each environment (serum and bronchoalveolar lavage fluid) were obtained by using "Receivers operating characteristic" curve. Determined individually, carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125, showed the greatest diagnostic accuracy in bronchoalveolar lavage fluid. Carbohydrate antigen 15-3 did so in serum. Carcinoembryonic antigen was the most relevant marker in bronchoalveolar lavage fluid. For the factors evaluated in this study, determination of carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125 in bronchoalveolar lavage fluid were clinically more useful markers in comparison with serum, although the latter may also be helpful in certain situations. Although there is no specific tumour marker for lung cancer, the combination of several can be used to diagnose most patients with lung cancer and also to rule out false positive and negative cases.

Cell block cytology in pleural effusion.

Cell blocks prepared from residual tissue fluid can be used as adjuncts to smear for establishing a more definitive cytopathological diagnosis. It can be useful for categorisation also. Improved ethanol formalin fixative is used which offers excellent cytomorphologic features corresponding closely to cell in Papanicolaou stained smears. The technique is simple, safe, cost effective and reproducible even in resource limited rural areas. In this study among a total of 60 cases of suspected malignant pleural effusion, 56 were confirmed to be of malignant aetiology by all modalities. Only cell block preparation diagnosed 46 cases. Other modalities of diagnosis like bronchoscopy, broncho-alveolar lavage fluid study, fine needle aspiration cytology also have a great role in diagnosis. Twenty-two cases were diagnosed by Papanicolaou stain smear. So cell block preparation have more effective role in definitive diagnosis. It can be useful for better diagnosis in cases of poorly differentiated malignant neoplasms by immunocytochemistry.

Knowledge, attitude and practice of smoking in subjects of lung cancer.

Lung cancer is the most common cancer in the world since 1988, both in terms of incidence and mortality among both men and women. Approximately half of the cases of lung cancer now occur in developing countries compared to 1980. Tobacco smoking is by far the predominant risk factor for lung cancer. A knowledge, attitude and practice of smoking among 132 cases of lung cancer in this study was undertaken. Amongst 113 ever smokers, out of 132 cases, 91.18% of males and 36.36% of female subjects continued smoking despite knowing the harmful effects of tobacco, displayed over the cigarette or bidi packets. In these group squamous cell carcinoma was the most common type followed by adenocarcinoma. Among the never smokers adenocarcinoma was the commonest type, females accounting for 75% of the cases, though a good number was observed among male ever smokers, signifying the changing histological types of lung cancer today.

Serum magnesium and stable asthma: Is there a link?

BACKGROUND: Although magnesium is used through intravenous and inhalation route in the management of asthma, actual prevalence of hypomagnesemia in asthma is not known. We conducted this study: 1) to detect the prevalence of hypomagnesemia in stable asthma and 2) to assess the significance of hypomagnesemia in these patients. DESIGN: Prospective clinical study. SETTING: Department of Respiratory Medicine, Calcutta National Medical College, Kolkata. PERIOD OF STUDY: Four months from January, 2007, to April, 2007. MATERIALS AND METHODS: Fifty patients attending outpatients department of respiratory medicine with stable asthma were randomly selected. They were assessed clinically and their serum magnesium levels were measured. This was compared with the serum magnesium values of 45 nonasthmatic healthy controls. RESULTS: Out of 50 patients, 14 had hypomagnesemia. Possible relationship of hypomagnesemia with tachycardia, tachypnoea, severity of asthma, medication use, and previous and future exacerbations were analyzed. CONCLUSION: There was statistically significant association of hypomagnesemia with tachypnoea, severe asthma, use of long-acting ß-agonist, inhaled corticosteroids, theophylline, use of ≥ 3 medications, previous and future exacerbations but not with tachycardia or use of short-acting ß(2) -agonist or montelukast.

Tuberculosis in a bronchogenic cyst.

Bronchogenic cyst is one of the subtypes of congenital pulmonary cyst. Superadded infection, mostly bacterial is the commonest complication. Myobacterial infection is very rare. Here a case of tuberculosis in a bronchogenic cyst is reported because of its rarity.

Transthoracic cutting needle biopsy: a valuable diagnostic procedure.

Intrathoracic mass lesions, especially peripherally situated masses, often present as a problem as tissue diagnosis is not always possible by cytopathological examination. Cutting needle biopsy may be the method of choice in selected cases for tissue diagnosis. Cutting needle biopsy is indicated for patients with peripherally situated mass lesions abutting chest wall, which are non-vascular and non-cystic in nature.

Attempts to assemble a universal NMR database without synthesis of NMR database compounds.

[structure: see text] The feasibility of assembling 3JH,H profiles from NMR data collected on relevant, but not necessarily specific, NMR database compounds representing a given stereocluster was demonstrated. By this approach, the 3JH,H profile was created for the contiguous tetraol peracetate stereocluster. The reliability and applicability of the database thus assembled were demonstrated for known peracetates derived from two heptoses.

Stereochemistry of sagittamide A: prediction and confirmation.

[structure: see text] The C5-C10 relative stereochemistry of sagittamide A was predicted, with the use of the 3JH,H profiles assembled from the spin-coupling constants reported in the literature. The predicted relative stereochemistry was then confirmed by a total synthesis of two relevant remote diastereomers. The absolute configuration of sagittamide A was established through a detailed 1H NMR analysis of the two remote diastereomers, followed by doping experiments of them with the authentic natural product.

Studies in chlorin chemistry. 3. A practical synthesis of c,d-ring symmetric chlorins of potential utility in photodynamic therapy.

[reaction: see text] C,D-ring symmetric chlorins 8 were prepared in 47-85% yield, on scales up to several hundred milligrams, by condensation of appropriately substituted bis-formyldihydrodipyrrins 6 and dipyrromethane bis-carboxylic acids 7 in 5% TFA/CH2Cl2 (25 examples). Target chlorins were chosen to systematically probe the effect of lipophilic and hydrophilic substituents on tissue partitioning and cellular membrane penetration in photodynamic therapy (PDT).

Studies in chlorin chemistry. II. A versatile synthesis of dihydrodipyrrins.

[reaction: see text] Dihydrodipyrrins are key building blocks for the synthesis of hydroporphyrins, many of which have important biological activity. The title compounds were prepared in stereo- and regioselective fashion by a three-step sequence consisting of (1) Pd(0)-catalyzed coupling-cyclization of 2-iodopyrroles with gamma-alkynoic acids to afford enelactones of the desired substitution pattern, (2) methylenation at the lactone carbonyl group employing the Petasis reagent, and (3) in situ enol-ether hydrolysis and amination of the resultant 1,4-diketone to close the pyrroline ring (nine examples). Yields for each step were generally high, although in substrates not blocked by geminal substitution aromatization to a dipyrromethane is a competing side reaction.

Synthetic Studies in Phytochrome Chemistry.

An account is given of the author's several approaches to the synthesis of the parent chromophore of phytochrome (1), a protein-bound linear tetrapyrrole derivative that controls photomorphogenesis in higher plants. These studies culminated in enantioselective syntheses of both 2R- and 2S-phytochromobilin (4), as well as several (13)C-labeled derivatives designed to probe the site of Z,E-isomerization during photoexcitation. When reacted in vitro, synthetic 2R-4 and recombinant-derived phytochrome apoprotein N-C produced a protein-bound chromophore with identical difference spectra to naturally occurring 1.

Application of chiral lanthanide shift reagents for assignment of absolute configuration of alcohols.

[structure: see text] The absolute configuration of secondary and tertiary alcohols can be predicted from analysis of the chemical shift behaviors of the CX- and CY-carbons in the presence of (R)- and (S)-Pr(tfc)3 as formulated in the boxes.

Use of a chiral praseodymium shift reagent in predicting the complete stereostructure of glisoprenin A.

[structure: see text] The complete stereostructure of glisoprenin A has been predicted via analysis of the 13C NMR behaviors in the presence of (R)- and (S)-Pr(tfc)3.

Validation of lanthanide chiral shift reagents for determination of absolute configuration: total synthesis of glisoprenin A.

[structure: see text] The complete stereostructure of the natural product (+)-glisoprenin A had been predicted via a novel application of chiral lanthanide shift reagents. Confirmation of the predicted stereostructure of (+)-glisoprenin A and validation of the chiral lanthanide shift approach have now been achieved through total synthesis.

Lewis acid-promoted oxidative addition of thioimidates to Pd0.

The isomeric S-methyldihydropyrrins 9-Z and 9-E exhibit markedly different behavior in Pd(0)-catalyzed cross-coupling reactions. Thioimidates 9-Z are readily converted to imines 10-Z employing Pd(0)/AlkZnI. Under identical conditions 9-E are inert. Oxidative addition to Pd(0) requires activation by Zn or other Lewis acids, which is sterically unfavorable with 9-E. Analogous results were obtained with the related thioimidates 11-E,Z as well as with methylthiopyridines 19alpha-gamma. In the case of both 11 and 19 oxidative addition to Pd(0) was greatly facilitated in the presence of BF(3) x Et(2)O. The importance of Lewis acid activation to Pd(0) oxidative addition in such substrates appears to be a general phenomenon not previously recognized.