Oral miltefosine treatment in children with mild to moderate Indian visceral leishmaniasis

BACKGROUND: Miltefosine is the first oral drug with demonstrable success in treating visceral leishmaniasis in adults. Because approximately one-half of the visceral leishmaniasis patients worldwide are children, we performed a Phase I/II dose ranging study in the pediatric population in India. METHODS: Thirty-nine (39) children (defined as < 12 years of age) with visceral leishmaniasis demonstrated by parasites in splenic aspirates, were treated with oral miltefosine daily for 28 days: 21 patients received 1.5 mg/kg/day (Group A); and 18 patients received 2.5 mg/kg/day (Group B). About one-half of these children had failed prior antileishmanial treatment. RESULTS: All patients were parasitologically negative and symptomatically improved by the end of therapy on Day 28 of therapy; the initial parasitologic cure rate was 100%. Two patients in each treatment group relapsed with fever, splenomegaly and parasite-positive splenic aspirates by the end of the 6-month follow-up. The per protocol final clinical cure rate was 19 of 21 = 90% in Group A and 15 of 17 = 88% in Group B. Miltefosine was well-tolerated. As per the adult experience, gastrointestinal adverse events were seen: 33 and 39% of children experienced vomiting and 5 and 17% experienced diarrhea in Groups A and B, respectively, but all episodes were mild to moderate in severity and commonly lasted <1 day without symptomatic treatment. CONCLUSION: Oral miltefosine was safe and approximately 90% effective in this initial clinical trial of childhood visceral leishmaniasis.     

Prolonged retention of vaccinia virus complement control protein following IP injection: implications in blocking xenorejection

The vaccinia virus complement control protein (VCP) blocks classic and alternate complement pathways by binding to the third and fourth complement components and by blocking the formation of the C3-convertase as well as by accelerating the decay of the C3 and C4 convertase. The therapeutic potential of VCP has been extensively studied for brain injury, xenotransplantation, Alzheimer's disease, and spinal cord injury. We investigated the pharmacokinetic behavior of rVCP in mice. Dosage of rVCP was studied by injecting different concentrations of rVCP. A 25 mg/kg or greater dose injected intraperitoneally was found to be adequate to suppress complement for more than 8 hours.     

Square cervical laminoplasty incorporating spinous process: surgical technique

BACKGROUND: We have used a laminoplasty technique in multilevel cervical canal stenosis that incorporates spinous process in the neural arch and does not require free graft or foreign material. METHODS:In this technique, laminae and spinous processes were used to enlarge stenotic cervical spinal canal. Three patients (mean age 34.6 years) formed the study group with a mean follow-up period of 24.6 months. Postoperative computed tomography (CT) and lateral radiographs were used to assess results in terms of bony union, canal diameter, and alignment of cervical spine. RESULTS: All patients noted some improvement in both sensory and motor functions. The average increase in sagittal diameter of cervical spinal canal was 4.2 mm, and decrease in range of motion (ROM) was 13.2 degrees. Bony fusions at the gutters were seen after 6 months. CONCLUSION: This new technique of cervical laminoplasty is safe, effective, relatively easy, and avoids complications related to free grafts or metallic or nonmetallic foreign materials used in other techniques     

Atresia of coronary sinus ostium with retrograde drainage via persistent left superior vena cava

Atesia of the coronary sinus ostium (ACSO) with retrograde drainage of cardiac veins via the left superior vena cava (LSVC) is a very rare abnormality. This condition is usually asymptomatic during life and a majority of the cases were reported as incidental postmortem findings. If there is retrograde venous drainage via persistent LSVC, this communication cannot be ligated irrespective of its size or the presence of a communicating vein because of resultant cardiac congestion and edema. We report herein a 9-month-old Chinese female who underwent repair of a perimembranous ventricular septal defect, patent ductus arteriosus and secundum atrial septal defect. During the operation, ligation of LSVC resulted in myocardial congestion and distension of the heart. The release of ligature decompressed the heart immediately.