Perinatal risk factors in neonatal infections

Perinatal risk factors were studied among 50 cases of neonatal septicemia and 200 matched normal neonates during one year period. The consanguinity among parents, birth order and sex of the baby did not increase the risk for developing septicemia. There was significant increase in the risk for septicemia when the duration of labour was more than 24 hours (P<0.01), time interval between rupture of membrane and delivery of baby was more than 12 hours (P < 0.001), liquor was meconium stained or foul smelling (P<0.001) and delivery was operative (P<0.01), The neonatal factors identified with risk for septicemia were preterm delivery (P<0.01), low birth weight (P<0.01), birth asphyxia (P < 0.001) assisted ventilation (P < 0.001) and intravenous alimentation (P<0.02). Identification of high risk pregnancies and appropriate management can minimize many of the above risk factors which in turn will reduce the occurrence of neonatal sepsis.     

Correlation of level of gangliosides in plasma with cancer in human patients

Levels of gangliosides in the plasma of human patients with cancers of the breast, cheek, oesophagus, rectum, penis, bladder and skin, as analysed by thin layer chromatography and quantitative densitometric scanning, were found to increase many fold (ranging from 3.5 to 5.96 folds), compared to that of normal individuals. The ganglioside levels in the plasma of patients with benign tumors were comparable to that of normal individuals, thus suggesting correlation between increased ganglioside levels in the plasma and malignant growth in cancer patients. These increased levels of gangliosides in the plasma of Ca-breast, Ca-cheek and Ca-penis gradually increased with the advancement of the disease and showed some correlation with the increase in stage of the disease. The levels of gangliosides in the plasma of patients with Ca-breast and Ca-cheek were found to decrease significantly after surgical removal of the primary cancerous growth. The results indicated diagnostic as well as prognostic significance of plasma ganglioside levels in human cancers.     

Primary anastomosis in difficult cases of type “C” esophageal atresia: The atraumatic microvascular clamp technique of minimal tension with good outcome

BackgroundSurgical maneuvers for esophageal anastomosis in difficult cases of Gross type “C” esophageal atresia (EA) are challenging. The methods of early primary anastomosis are technically difficult and staged surgeries expose the child to repeated general anesthesia with problems of nursing care. We describe a simple method of partial disconnection of the lower esophagus from the fistula followed by approximation by an atraumatic microvascular clamp. The suitability of this method and its outcomes are discussed.MethodsIt was a prospective observational study that included 32 patients of type “C” EA between January 2014 and December 2016. Babies with birth weight more than 2 kg without cyanotic heart defects and requirement of intensive care were included. An early primary anastomosis using this technique was tried in all. A cervical esophagostomy with feeding gastrostomy was done where it was not possible. Analysis of the gap and post operative outcomes i.e. gastroesophageal reflux (GER), stricture, tracheomalacia, dysmotility, recurrence and survival were analyzed.ResultsThe mean gap between esophageal ends was 4.3 cm. Primary anastomosis was possible in 26 (81.25%). Minor and major leak occurred in 3 (11.54%) and 1 (3.85%) patients respectively. Survival was 84.62% (22/26). All mortalities were early post operative. During mean follow up of 23.73 months (till December 2019), GER decreased from 63.64% (14/22) to 13.64% (3/22), partial stricture was seen in 18.18% (4/22), tracheomalacia in 36.36% (8/22) and dysmotility in 77.27% (17/22). There was no recurrence of fistula. Complications with this method did not show any significant difference as mentioned with other methods.ConclusionThis technique seems to be physiologically suitable as it enables anastomosis with minimal trauma to the esophageal ends. It is easy, reproducible and produces favorable outcomes comparable with other methods for difficult cases of type “C” esophageal atresia (EA).     

Utility of PAS and β-catenin staining in histological categorisation and prediction of prognosis of hepatoblastomas

Aims

The aim of this study was to assess the usefulness of PAS, β-catenin and Ki-67 in categorising hepatoblastomas (HBs) and their significance in predicting prognosis. In addition, we have also documented the various chemotherapy induced histologic changes in HBs.

Method

In this retrospective observational study of 29 cases of hepatoblastomas, 27 cases were considered for statistical analysis, excluding two cases of diagnostic core biopsies. All clinicopathological parameters and follow up data were collected. All HB cases including the mixed epithelial and mesenchymal HBs were classified into two groups: fetal predominant and embryonal predominant type according to the predominant epithelial component. PAS, β-catenin and Ki-67 staining were done and their correlation with histologic subtypes was assessed. Kaplan–Meier survival analysis was performed in relation to histology, PAS, β-catenin and Ki-67 staining characteristics.

Result

Diffuse nuclear staining of β-catenin was significantly more common in embryonal predominant type (p = 0.036), whereas strong PAS positivity was significantly associated with fetal predominant type (p = 0.002). But no significant correlation was seen between histologic type and Ki-67 staining (p = 0.42). Survival analysis showed cases with diffuse PAS positivity, focal nuclear β-catenin staining and low Ki-67 LI had better survival.

Conclusion

PAS is a simple stain and can be utilised in histological categorisation of HB and also predicting its outcome. Nuclear β-catenin staining which is significantly common in embryonal elements in HB predicts shorter survival.

     

Generalized lymphadenopathy caused by Trichosporon asahii in a patient with Job's syndrome.

Of the six species of Trichosporon known to cause human infections, T. asahii is the main agent of invasive trichosporonosis. We describe an unusual case of generalized lymphadenopathy due to T, asahii in a 10-year-old boy with Job's syndrome (markedly elevated IgE with eosinophilia). The diagnosis was based on the presence of blastic conidia and hyphal elements breaking into arthroconidia in biopsied tissue of the cervical lymph node and isolation of the causal agent T, asahii in pure culture. The patient responded initially to amphotericin B therapy, but the infection recurred within 4 weeks and did not respond to therapy of liposomal amphotericin B and 5-fluorocytosine for 10 days. The patient left the hospital against medical advice.     

Defective CD19-dependent signaling in B-1a and B-1b B lymphocyte subpopulations

Peritoneal and pleural cavities in mice and humans contain a unique population of B-lymphocytes called B-1 cells that are defective in B cell antigen receptor (BCR) signaling but have an increased propensity to produce autoantibodies. Several molecules such as Btk, Vav, and CD19 known to be important for BCR signaling have been shown to be critical for the development of B-1 cells from undefined precursors. Here we demonstrate that B-1 cell unresponsiveness to BCR cross-linking is in part due to defective signaling through CD19, a molecule known to modulate signaling thresholds in B cells. The defective CD19 signaling is manifested in reduced synergy between mIgM and CD19 to stimulate calcium mobilization in B-1 cells. BCR induced tyrosine phosphorylation of CD19 was transient in B-1 cells while it was prolonged in splenic B-2 cells. In both B-1 and B-2 cells BCR cross-linking induced a modest increase of CD19 associated Lyn, a Src family protein tyrosine kinase (PTK) thought to be important for CD19 phosphorylation. However, the tyrosine phosphorylated CD19 in B-1 cells binds less phosphatidylinositol 3-kinase (PI3-K) compared to B-2 cells. Most interestingly, we find that Vav-1 and Vav-2, proteins thought to be critical for CD19 signal transduction, are severely reduced in B-1 cells resulting in a complete absence of any CD19 associated Vav. Also we showed that both B-1a and B-1b B cells failed to proliferate in response to BCR cross-linking which in part appears to be due to defects in CD19 mediated amplification of BCR induced calcium mobilization.     

Expression of p57(KIP2) potently blocks the growth of human astrocytomas and induces cell senescence

Astrocytic tumors frequently exhibit defects in the expression or activity of proteins that control cell-cycle progression. Inhibition of kinase activity associated with cyclin/cyclin-dependent kinase co-complexes by cyclin-dependent kinase inhibitors is an important mechanism by which the effects of growth signals are down-regulated. We undertook the present study to determine the role of p57(KIP2) (p57) in human astrocytomas. We demonstrate here that whereas p57 is expressed in fetal brain tissue, specimens of astrocytomas of varying grade and permanent astrocytoma cell lines do not express p57, and do not contain mutations of the p57 gene by multiplex-heteroduplex analysis. However, the inducible expression of p57 in three well-characterized human astrocytoma cell lines (U343 MG-A, U87 MG, and U373 MG) using the tetracycline repressor system leads to a potent proliferative block in G(1) as determined by growth curve and flow cytometric analyses. After the induction of p57, retinoblastoma protein, p107, and E2F-1 levels diminish, and retinoblastoma protein is shifted to a hypophosphorylated form. Morphologically, p57-induced astrocytoma cells became large and flat with an expanded cytoplasm. The inducible expression of p57 leads to the accumulation of senescence-associated beta-galactosidase marker within all astrocytoma cell lines such that approximately 75% of cells were positive at 1 week after induction. Induction of p57 in U373 astrocytoma cells generated a small population of cells ( approximately 15%) that were nonviable, contained discrete nuclear fragments on Hoechst 33258 staining, and demonstrated ultrastructural features characteristic of apoptosis. Examination of bax and poly-(ADP ribose) polymerase levels showed no change in bax, but decreased expression of poly-(ADP ribose) polymerase after p57 induction in all astrocytoma cell lines. These data demonstrate that the proliferative block imposed by p57 on human astrocytoma cells results in changes in the expression of a number of cell cycle regulatory factors, cell morphology, and a strong stimulus to cell senescence.     

Midline cervical cleft: A report of two cases

Congenital midline cervical cleft is a rare congenital anomaly. The cardinal diagnostic features are-(1). Fistula's opening are located caudally (2) Internuittent serous fluid discharge in the early neonatal period (3). Nipple like appearance of the cleft in the superior aspect (4). Widened scar and mininual neck contracture in later life. Two such cases are reported herewith with briefreview of literature and it's surgical management.