A review of non-invasive imaging in extramammary Paget's disease.

Extramammary Paget's Disease (EMPD) is a rare intraepithelial adenocarcinoma that classically manifests with pruritic, erythematous and scaling plaques. The clinical picture frequently mimics inflammatory or infectious conditions and is thus commonly misdiagnosed. The assessment of tumour margins is equally challenging as tumours have a propensity to spread beyond clinically visible boundaries. Appropriate non-invasive diagnostic tools can assist in the early detection, diagnosis and management of EMPD. This paper will review the literature on non-invasive imaging modalities used in EMPD. Articles from the PubMed database were selected based on relevance to the topic of this review. Articles that were not specific to EMPD and non-invasive imaging were excluded. Search strategy is further described in the methods section below. Eighteen articles were selected for this review: six PET/CT, five reflectance confocal microscopy (RCM), two photodynamic diagnosis (PDD), two dermoscopy, two MRI and one optical coherence tomography (OCT) paper(s). Dermoscopy, PDD, RCM and OCT can help to distinguish malignant conditions, including EMPD, from benign conditions. RCM and OCT can identify atypical cells in real-time, and have the potential to improve the accuracy of surgical margins intraoperatively and overall management. Distinctive confocal characteristics of EMPD have been described using RCM. The sensitivity and specificity of these findings require additional validation. Radiographic techniques also play a central role in the diagnosis of EMPD and assessment of disease spread. PET/CT and MRI can detect primary disease, nodal and distant metastases, with superior delineation of disease spread on MRI. Limitations of PET/CT are mainly related to primary tumour thickness, and size and FDG-avidity of nodal and distant metastases. Limitations of MRI include the fact that few studies have examined its use in EMPD; additional research is warranted. Randomized controlled trials and large prospective studies evaluating the use of non-invasive imaging in EMPD are needed.

A retrospective analysis of hypertension screening at a mass gathering in India: implications for non-communicable disease control strategies.

Cardiovascular disease is the leading case of mortality from non-communicable diseases (NCD) in India. The government's National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke seeks to increase capacity building, screening, referral and management of NCDs across India, and includes community-based outreach and screening programmes. The government in India routinely provides basic care at religious mass gatherings. However, in 2015, at the Kumbh Mela in Nashik and Trimbakeshwar, the state government extended its services to include a hypertension screening programme. We examine here the value and implications of such opportunistic screening at mass gatherings. At the Kumbh, 5760 persons voluntarily opted for hypertension screening, and received a single blood pressure measurement. In all, 1783 (33.6%) screened positive, of whom, 1580 were previously unaware of their diagnosis. Of the 303 that had previously known hypertension, 240 (79%) were prescribed medications, and 160 were compliant (that is, 52.8% under treatment). Fifty-five (18%) had normal blood pressure readings (BP under control). The data also demonstrated higher prevalence (39%) of hypertension among tobacco users compared to non-users (28%) (P<0.001). Poor recording of phone numbers (0.01%) precluded any phone-based follow-up. The low rates of hypertension awareness, treatment and control underscore the ongoing challenge of both hypertension screening and management in India.

Methicillin resistant Staphylococcus aureus colonization in pigs and pig farmers.

Methicillin resistant Staphylococcus aureus (MRSA) colonization has recently been identified in pigs and people that work with pigs, raising concerns about the role of pigs as reservoirs of MRSA for human infection. The objectives of this study were to evaluate the prevalence of MRSA colonization in pigs and pig farmers in Ontario, Canada and to characterize MRSA strains. Nasal and rectal swabs were collected from 285 pigs from three different age groups from 20 pig farms. Nasal swabs were collected from farm personnel and a brief questionnaire was also administered. The prevalence of MRSA colonization in farms was 45% (9/20) whereas the prevalence in pigs was 24.9% (71/285). There was no difference in MRSA colonization between age groups. The prevalence of MRSA colonization in pig farmers was 20% (5/25). There was a correlation between the presence of MRSA in pigs and humans on farms (P value=0.001). The results of spa typing revealed the predominant strain in pigs and humans was eGenomics spa type 539 (Ridom t034, clonal complex 398) which accounted for 59.2% of isolates and has been reported in pigs in Europe. A common human epidemic clone, CMRSA-2 (USA100, clonal complex 5) was also found in both pigs and pig personnel. Indistinguishable strains were found in pigs and pig personnel on all five farms with a colonized human. This study demonstrates that MRSA is common in pigs in Ontario, Canada, and provides further support to concerns about transmission of MRSA between pigs and humans.

An anomaly in the isotopomer shift of the hyperfine spectrum of LiI.

A high-precision examination of the hyperfine spectrum of 6LiI in comparison with 7LiI shows a shift in the iodine nuclear electric quadrupole moment that cannot be accounted for by a model in which the electric field gradient at the iodine site is assumed to depend only upon the internuclear distance between Li and I. The other hyperfine interactions are consistent between the two isotopomers, including the previously reported electric hexadecapole interaction of the iodine nucleus.

Western blot analysis of serological response in Helicobacter pylori in acid peptic diseases.

A prospective study was undertaken in 70 patients presenting with acid peptic disease with the objective of characterising the serological response to Helicobacter pylori and finding antigens specific for the serodiagnosis of H. pylori infection. H. pylori status was assessed by smear microscopy, rapid urease activity, culture and histopathology of endoscopic gastric antral biopsy specimens. Serological characterisation was carried out by using western blotting of various antigenic components of H. pylori and subsequent enzymatic detection of antibodies against them. Four reactive bands in the molecular weight range of 45-65 kDa were present in all subjects irrespective of H. pylori status. Four to six immunoreactive bands in the molecular weight range of 21-45 kDa were found only in patients with positive H. pylori status and histopathologically proven gastritis. These immunoreactive components may be valuable in specific immunodiagnosis of H. pylori infection.

Strategies for purification of four reproductive hormones from the same batch of buffalo (Bubalus bubalis) pituitaries.

The occurrence of different reproductive hormones like LH, FSH, TSH and prolactin, in different side fractions obtained during the extraction of buffalo pituitary glands either by the procedure of Papkoff et al. [Arch Biochem Biophys, 111 (1965) 431] or by that of Ellis [Endocrinology, 69 (1961) 554], was examined with the aid of antisera to respective heterologous hormones as well as bio-assays. Thus in the procedure of Papkoff et al., the SP-Sephadex fractions could be taken for purification of LH and TSH, while the acid pellet yielded prolactin. Further it was shown that 50% (NH4)2SO4 could be directly size fractionated and following cation exchange chromatography yields LH and TSH. FSH could be purified from 80% ammonium sulphate pellet. In another protocol of Ellis, differential extraction and chromatographic separation yielded all the four reproductive hormones. Some of the physico-chemical and immunobiological characteristics of these hormones are described.

Immunization with outer-membrane protein(s) of Bacteroides fragilis: an experimental study in mice.

A crude outer-membrane protein (OMP) preparation from a strain of Bacteroides fragilis, grown in supplemented brain-heart infusion broth, was tested for its protective effect against subcutaneous infection in mice. Immunization with six doses, each of 100, 150 or 200 µg OMP preparation, gave some protection: abscesses completely disappeared 15 to 22 days after immunization. In non-immunized animals and animals immunized with doses of 10, 20, 40 or 80 µg each, well demarcated abscesses were seen beyond day 22 post-immunization. Although crude OMP elicited good antibody response, with maximum titres on day 4 post-immunization, high titres could not be associated with healing of the abscesses.

Recognition of immunologically important antigens in Bacteroides fragilis infection -an experimental study in mice.

When the outer membrane proteins (OMP) of Bacteroides fragilis ATCC 23745 grown under seven different culture conditions were analysed by SDS-PAGE, five of the seven preparations showed similar protein profiles. When the three different OMP preparations were subsequently analysed by Western blotting, that from B. fragilis grown in brain heart infusion broth supplemented with haemin and menadione alone showed more immunodominant bands than those grown with additional cholesterol and methionine or cholesterol and cysteine. Only the former showed immunodominant proteins around 45.6 kDa and 66.2 kDa throughout the course of infection in mice. A protein corresponding to 97.4 kDa was found under all culture conditions. The results emphasise the importance of culture conditions in the expression of immunologically reactive antigens and also the possible use of such antigens in the serodiagnosis of B. fragilis infection.

Enzyme linked immunosorbent assay & indirect fluorescence assay for rapid diagnosis of Bacteroides fragilis infections.

Antibodies for B. fragilis (NCTC 9343) were detected in sera of 121 patients and 37 controls using four methods viz., enzyme linked immunosorbent assay (ELISA), indirect fluorescence test (JFA), countercurrent immunoelectrophoresis (CIE) and indirect haemagglutination test (IHA). Of 121 patients, 57 were culture positive for B. fragilis, 38 positive for anaerobes other than B. fragilis and 26 were negative for anaerobes. In the B. fragilis culture positive group, antibodies to B. fragilis were positive in 82.5, 84.2, 85.90 and 91.2 per cent patients by CIE, ELISA, IHA and IFA respectively. In B. fragilis positive patients IFA was more sensitive than IHA, which for other groups IHA was found to be more sensitive than IFA. When all groups were taken together IHA was found more sensitive than IFA. ELISA and IFA tests are recommended for rapid serological diagnosis of B. fragilis infections, where facilities for these tests are not available, CIE and IHA could be done. Cross reactivity with other Gram negative anaerobic and aerobic bacteria should be kept in mind since seropositivity varied for B. fragilis (82-91%). In infections with microbes other than B. fragilis seropositivity varied between 23.7 to 63.2 per cent and in patients having cultures sterile or positive for other organisms seropositivity was 30.8 to 42.3 per cent. This nonspecificity could be due to other antigens that cross react between B. fragilis and other anaerobes and aerobes or the use of an antigen lacking high purity.

Exploration of the common bile duct through the cystic duct.

Formal exploration of the common bile duct through choledochotomy is a standard surgical technique; however, the prevalence of postoperative morbidity and mortality from intraoperative extraction of stones and debris of the common duct remains significant. From 1982 to present, we performed 25 explorations of the common bile duct entirely through the cystic duct in patients in whom duct size was large enough to permit passage of instrumentation greater than 6.5 millimeters in diameter. All instrumentation, including biliary Fogarty balloon-tipped catheterization and fiberoptic choledochoscopy, was used through the cystic duct without difficulty. No complications of bile leakage or stricture formation were encountered, and all patients are doing well at five and one-half years after surgical treatment without known retained stones. The early community hospital experience of this report supports the view that exploration of the common bile duct through a suitably sized cystic duct is a safe, efficient and effective alternative to choledochotomy for exposure of the common bile duct.