Disseminated coxsackievirus B fulminant myocarditis in an immunocompetent adult: A case report: Case of disseminated coxsackievirus myocarditis

Coxsackieviral myocarditis is associated with systemic involvement in neonates; however, fulminant coxsackieviral myocarditis is rare in adults, and its dissemination with fatal myocarditis involving kidneys, liver, and adrenal is further rarely reported. We report a case of fulminant myocarditis along with dissemination of coxsackievirus, which was clinically unrecognized.     

Pattern of subtypes of acute lymphoblastic leukemia in India

Leukemic cells from 124 acute lymphoblastic leukemia (ALL) and 31 chronic lymphatic leukemia (CLL) were examined for sheep erythrocyte receptor (E), surface immunoglobulin (SIg) and their reactivity with a panel of monoclonal antibodies recognizing specific surface antigens including pan-T, Common ALL and Ia antigens. In acute lymphatic leukemia, 33% of patients reveal T-cell receptor associated with higher age group, mediastinal mass and high WBC count. Common ALL was predominant between 2 and 9-yr age group. Among chronic lymphatic leukemia, 2 patients were found to be T-CLL while 29 revealed presence of SIg. Ia antigen was detected in 44.4% of ALL and 64% fo CLL patients. The pattern of surface marker observed in our series may be related to our life style, socio-economic and environmental factors.     

Aggressive chemotherapy in endodermal sinus tumor

Twenty-eight patients with pure or predominantly endodermal sinus tumor were studied for their clinical behavior, relation with serum alpha-fetoprotein (AFP), and response to intensive postoperative combination chemotherapy. Eight percent of the patients were younger than 20 years of age. One patient was a pseudohermaphrodite. Serum AFP was estimated in 17 patients and was elevated in all. Seven patients were treated with adjuvant chemotherapy following surgery with a cisplatin-containing combination. Five patients (71%) are alive and continue to remain free of disease, with a median survival of 28 months after treatment and an overall median survival of 34 months. Two patients treated with adjuvant chemotherapy experienced early recurrence of the disease, which was detected with a rise in serum AFP before the clinical manifestation of recurrence.     

Steady-state serum concentrations after cis (Z)-flupentixol decanoate in viscoleo

Serum concentrations of cis(Z)-flupentixol have been measured in patients on cis(Z)-flupentixol decanoate injections during successive dosage intervals of 2–4 weeks. The calculation of the fluctuation of the serum concentration in the dosage interval indicates that each individual patient should have his own dosage interval. For the 2-week group a significant correlation was found between weekly dose and preinjection concentration (r=0.79) although an interindividual variability of ×4 was found. For this group the relative within-patient variation in the pre-injections concentration was calculated to be 9.6%, showing that a constant dosage regimen in the individual patient leads to an almost constant drug load.     

Studies on the pathological effects of feeding betel-nut meal in albino rats

The pathological effects of betel-nut meal consumption in weaned albino rats were studied for a period of 4 weeks. In higher concentrations (60-100%), toxic effects were observed. The rats showed severe diarrhoea and died within 1-3 weeks depending upon the amount of betel-nut meal consumed. In lower concentrations (5-10%), no grossly detectable pathological changes were observed in any one of the experimental rats. With the increase in the concentration of betel-nut meal in the experimental diets, the pathological changes were intensified gradually. The pathological changes observed in the rats fed with experimental diets containing more than 15% betel-nut meal were necrosis of the buccal and intestinal mucosa, splenomegaly, fatty changes in the liver and stunted skeletal growth. Catarrhal enteritis was observed in the rats fed with 15% betel-nut meal and haemorrhagic gastroenteritis was observed when the concentration of the betel-nut meal was raised above 15%.     

Behavior of B, Cr, Se, As, Pb, Cd, and Mo present in waste leachates generated from combustion residues during the formation of ettringite

The behavior of B, Cr, Se, As, Pb, Cd, and Mo in the leachates generated from two combustion residues, coal-fired power plant fly ash and municipal solid waste incineration ash, during precipitation of ettringite is presented. Experiments also were performed using modeled waste leachates as well as controlled solutions containing all the investigated elements. Moreover, to determine the possible effect of pH, lime treatment was conducted using the waste and modeled leachates. Results indicated the removal of B, Se, and Cr from the leachates because of incorporation of their oxyanions in the ettringite structure. The removal of B could further be explained by considering the structure of ettringite and monosulfoaluminate. The removal of Pb also occurred, probably because of lime-induced precipitation of Pb(OH)2. Similarly, the removal of As was observed as a result of lime-induced precipitation of Ca3(AsO4)2 and incorporation into the ettringite structure. On the other hand, the precipitation of ettringite did not reduce the concentrations of Mo and Cd because of the complex nature of these elements in the leachates. The results also suggest that the presence of high amounts of constituents such as Cl-, an alkali metal in the solution, also affected ettringite precipitation behavior. Moreover, elemental speciations as well as the presence of other constituents in the solution affected the incorporation by ettringite.     

Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green

AIM: To investigate macular function and morphology after surgical removal of idiopathic epiretinal membrane (IEM) with and without assistance of indocyanine green (ICG). METHODS: A retrospective study as a consecutive case series, of 39 patients with IEM. 39 patients, 23 female, 16 male, mean age 67 years, underwent standard three port pars plana vitrectomy with removal of epiretinal membrane. Two groups of patients were consecutively operated: in 20 patients ICG 0.1% in glucose 5% was used to stain the epiretinal membrane. 19 patients underwent the identical procedure but without use of ICG. Postoperative follow up was 1-92 months (mean 15.5 months). Functional outcome was assessed with subjective improvement, best corrected visual acuity (BCVA), Amsler grid test, 10 degrees and 30 degrees automated perimetry (Heidelberg visual field analyser) (HFA), and Goldmann kinetic perimetry. Macular morphology was assessed with stereoscopic biomicroscopy and optical coherence tomography (OCT). The main outcome measures were macular function as determined by BCVA, presence of visual field defects, and metamorphopsia as determined by Amsler grid test, macular morphology as determined by slit lamp biomicroscopy, and OCT. RESULTS: BCVA improved in 28 patients, remained unchanged in eight patients, and decreased in three patients. Improvement of BCVA was statistically significant in both groups (p = 0.003). Mean BCVA in patients operated with ICG improved from 0.33 preoperatively to 0.53 postoperatively. Mean BCVA in patients operated without ICG improved from 0.32 preoperatively to 0.54 postoperatively. Reduction of macular oedema as measured by OCT was statistically significant in both groups (p<0.01). There was no statistically significant difference in postoperative BCVA, macular oedema as measured by OCT, postoperative Amsler grid test, and subjective improvement between the two groups. The incidence of residual or recurrent epiretinal membrane was greater in the group operated without ICG (p = 0.014). Visual field defects were detected in one patient operated with ICG and in three patients operated without ICG. CONCLUSIONS: Removal of epiretinal tissue with or without assistance of ICG improved visual function and reduced macular oedema in most patients. Adverse effects clearly attributable to the use of ICG were not observed but further investigation is warranted.     

Gastric tuberculosis presenting as linitis plastica: a case report and review of the literature

Gastric tuberculosis is rare and usually presents as an ulcerated lesion or gastric outlet obstruction. Rarer presentations include massive gastrointestinal bleed and gastric perforation. A case of gastric tuberculosis presenting as linitis plastica is reported here. This is the first such case report. The patient was a young woman who presented with non-specific abdominal pain and significant weight loss. The gastric mucosa appeared oedematous and hyperaemic and there was spontaneous oozing of blood on upper gastrointestinal endoscopy. Computed tomography of the abdomen revealed diffuse thickening of the gastric wall. The diagnosis was confirmed by the presence of caseating granulomas with acid fast bacilli in the endoscopic biopsy specimen. The patient showed significant clinical improvement on four-drug anti-tuberculous treatment.     

Clinical profile of dasatinib in Asian and non-Asian patients with chronic myeloid leukemia

Resistance and intolerance to imatinib are of particular clinical relevance to Asian patients because of their lower body surface area. Dasatinib is 325-fold more potent than imatinib in inhibiting BCR-ABL in vitro and is indicated for the treatment of chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia resistant or intolerant to imatinib. Data from a series of phase I/II research trials were analyzed to compare the efficacy, safety and pharmacokinetic profile of dasatinib 70 mg twice daily in Asian and non-Asian patients. Results from 55 Asian and 615 non-Asian patients demonstrated that the efficacy and safety of dasatinib was comparable. Dasatinib was well tolerated, with no observed toxicities exclusive to Asian patients. A higher incidence of adverse events and lower rate of response observed among Asian patients with myeloid blast phase CML reflected the aggressive nature of the disease. Analyses of noncompartmental pharmacokinetics (5 Asian and 49 non-Asian patients) and population pharmacokinetics (17 Asian and 382 non-Asian patients) were also comparable. The efficacy, safety and pharmacokinetic profile of dasatinib 70 mg twice daily is similar in Asian and non-Asian patients with CML. Dasatinib is therefore an important therapeutic option for this patient population.