High prevalence of hepatitis C virus infection and genotype distribution among general population, blood donors and risk groups.

The prevalence of hepatitis C virus (HCV) infection in the general population and in various high risk groups in south India was assessed. A total of 258 out of 3589 (7.1%) subjects (both general and risk groups) tested positive for HCV RNA by RT-PCR, while the third generation ELISA detected only 6.1% (221/3589). This suggests that a number of cases go unreported, as screening of blood and blood products is done primarily by ELISA. Among 124 chronic renal failure (CRF) patients with a history of renal transplant or haemodialysis, 37% were found to be positive for HCV RNA by RT-PCR. We also found a significantly higher rate of transmission of HCV among people exposed to tattooing (2.8%) and pilgrims (5.8%) (slashing a cultural practice in one sect of Muslims). In addition, our studies also reveal a high prevalence of HCV infection (44%) among patients with Lichen planus. The most prevalent genotype observed in our population was 1b (43.4%) followed by 3b (30.2%). The other genotype 1a was observed in 16.6% of patients followed by 3a observed in 3.4% of the patients. Our findings suggest that HCV may be the major cause of post-transplant hepatitis in Indian patients with CRF and indicate the necessity for stringent screening procedures for these viral infections.     

Primary hepatic peripheral T-cell lymphoma associated with Epstein-Barr viral infection

Primary hepatic peripheral T-cell lymphoma(H-PTCL) is one of the rarest forms of non-Hodgkin lymphoma. We report a patient who presented with worsening jaundice, abdominal pain, and vomiting. Laboratory values were significant for elevated total bilirubin, alkaline phosphatase, and liver aminotransferases. Following a liver biopsy, histopathology revealed several large dense clusters of atypical T-lymphocytes which were CD2+, CD3+, CD5+, CD7-, CD4+, CD8-, CD56-, CD57-, CD30+ by immunohistochemistry. The proliferation index was approximately 70% by labeling for ki67/mib1. The above histological profile was consistent with peripheral T-cell lymphoma of the liver. Epstein-Barr viral serology indicated a remote infection, a likely risk factor for PTCL. Bone marrow biopsy was negative for malignancy, further supporting hepatic origin.     

The role of brain oscillations as functional correlates of cognitive systems: a study of frontal inhibitory control in alcoholism.

Event-related oscillations play a key role in understanding the brain dynamics and human information processing. In the present study, the Go/No-Go paradigm has been used to examine whether alcoholics have poor inhibitory control as compared to control subjects in terms of different oscillatory brain responses. The matching pursuit algorithm was used to decompose the event-related electroencephalogram into oscillations of different frequencies. It was found that alcoholics (n=58) showed significant reduction in delta (1.0-3.0 Hz) and theta (3.5-7.0 Hz) power during No-Go trials as compared to controls (n=29). This reduction was prominent at the frontal region. The decreased delta and theta power associated with No-Go processing perhaps suggests a deficient inhibitory control and information-processing mechanism. A neuro-cognitive model has been provided to explain the findings. It is suggested that the oscillatory correlates during cognitive processing can be an endophenotypic marker in alcoholism.     

Dual sensory innervation of the dorsum of the thumb

The value of the thumb has been described as being almost equal to the rest of the fingers combined (Decker and du Plessis, eds. 1986, Lee McGregor's synopsis of surgical anatomy. 12th ed. p 496). Normal hand function is dependent upon the integrity of both the sensory and motor innervation of the thumb. A thorough knowledge of normal and anomalous sensory innervation of the digits has clinical application because of the increased use of local anesthesia and developments in plastic surgery involving the skin of the digits. Herein is reported an unusual variation in the sensory innervation of the thumb in an adult cadaver. The normal innervation of the dorsum of the thumb is reviewed, and the clinical importance of this variation is discussed.     

An in vitro assessment of bioaccessibility of arsenicals in rice and the use of this estimate within a probabilistic exposure model

In this study, an in vitro synthetic gastrointestinal extraction protocol was used to estimate bioaccessibility of different arsenicals present in 17 rice samples of various grain types that were collected across the United States. The across matrix average for total arsenic was 209 ng/g±153 (\[xmacr]±2σ). The bioaccessibility estimate produced an across matrix average of 61%±19 (\[xmacr]±2σ). The across matrix average concentrations of inorganic arsenic (iAs) and dimethylarsinic acid (DMA) were 81?ng/g±67.7 and 41 ng/g±58.1 (\[xmacr]±2σ), respectively. This distribution of iAs concentrations in rice was combined with the distribution of consumption patterns (from WWEIA) in a Stochastic Human Exposure and Dose Simulator model to estimate population-based exposures. The mean consumption rate for the population as a whole was 15.7 g per day resulting in a 0.98 μg iAs per day exposure. The mean consumption rate for children 1-2 years old was 7 g per day resulting in a 0.48 μg iAs per day exposure. Presystemic biotransformation of DMA in rice was examined using an in vitro assay containing the anaerobic microbiota of mouse cecum. This assay indicated that DMA extracted from the rice was converted to dimethylthioarsinic acid, although a second oxygen-sulfur exchange to produce DMDTA was not observed.     

Inflammatory pseudotumor: the great mimicker

OBJECTIVE: The purpose of this review is to describe the pathophysiologic findings, differential diagnosis, imaging features, and management of inflammatory pseudotumor in various locations throughout the body. CONCLUSION: Inflammatory pseudotumor is a rare benign process mimicking malignant processes and has been found in almost every organ system. Radiologists should be familiar with this entity as a diagnostic consideration to avoid unnecessary surgery.     

F-18 FDG and C-11 methionine PET/CT in intracranial dural metastases

A 58-year-old woman with breast carcinoma, after mastectomy, radiotherapy, and chemotherapy, underwent a whole-body F-18 FDG PET/CT for restaging, which revealed multiple skeletal metastasis. Hypometabolism was noted in the right frontal lobe. The patient subsequently underwent a C-11 methionine brain scan, which demonstrated multiple dural-based metastatic foci confirmed on contrast-enhanced MR. FDG PET has limitations in brain tumor detection. Amino acid tracers are particularly attractive for imaging of brain tumors because of relatively high tumor to brain activity ratios.     

Prevalence of hepatitis B and hepatitis C viral infections in Indian patients with chronic renal failure

The present study reports prevalence of posttransplant hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in 256 patients with chronic renal failure (CRF) and with a history of either renal transplant or hemodialysis. Out of 256 patients 138 had renal transplant and 118 were on maintenance hemodialysis. Among the patients screened, 7% had HBV infection alone, 46% were infected with HCV alone, while 37.10% were found to have co-infection of both the viruses. Our findings implicate these viruses as the major cause of posttransplant hepatitis in Indian patients with CRF and indicate implementation of stringent screening procedures for these two viral infections.     

Resting EEG in offspring of male alcoholics: beta frequencies.

This study examines the differences in beta (12-28 Hz) band power in offspring of male alcoholics from densely affected alcoholic families. We have attempted to investigate if the increase in beta power is a 'state' or 'trait' marker for alcoholism. This study also explores the gender differences in the expression of this potential risk marker. Absolute beta power in three bands-beta 1(12-16 Hz), beta 2 (16-20 Hz), and beta 3 (20-28 Hz)-in the eyes closed EEG of 171 high risk (HR) subjects who were offspring of male alcoholics and 204 low risk (LR) subjects with no family history of alcoholism, were compared for each gender separately using a repeated measures analysis of variance design. Alcoholic and non-alcoholic subjects within the high risk group were compared using a repeated measures design as a follow-up analysis. The present study demonstrated increased beta power in the resting EEG of offspring of male alcoholics. Male HR subjects had higher beta 1 (12-16 Hz) power and female HR subjects had increased power in beta 2 (16-20 Hz) and beta 3 (20-28 Hz) as compared with low risk participants. Female HR subjects also showed significantly increased beta 2 and beta 3 power if they had two or more alcoholic first-degree relatives when compared with HR females having only an affected father. Risk characteristics are expressed differentially in males and females and may be an index of differential vulnerability to alcoholism. The results indicate that increased EEG beta power can be considered as a likely marker of risk for developing alcoholism and may be used as a predictive endophenotype.     

Role of ultrasound screening for gallbladder disease in pretransplant patients

There is no uniform data regarding prophylactic cholecystectomy in patients undergoing renal transplantation with gallbladder disease. Data analyses suggest that posttransplant patients on cyclosporine have a higher incidence of gallbladder calcifications compared with nonimmunosuppressed patients. Laparoscopic cholecystectomy is a relatively safe procedure in modern-day surgery. Taking these facts into consideration, we attempted to compare risks and complications associated with gallbladder disease and eventual cholecystectomy in pretransplant versus posttransplant patients. Between June 1999 and December 2005, 210 renal transplants were performed at our institution. One hundred four patients who had transplants before April 2003 were not screened for gallbladder disease and nine of these patients developed gallbladder disease. These patients form our control group. One hundred six patients who had transplants after April 2003 had pretransplant screening for gallbladder disease and 11 patients were identified with gallbladder disease. These patients form our study group. Nine patients who developed gallbladder disease after renal transplant underwent laparoscopic cholecystectomy with three resulting morbidities (33%), two graft losses (22%), and one mortality (11%). There was one mortality (11%) in this group. One patient in the study group died of acute gallstone pancreatitis. Of the 11 patients who were found to have gallbladder disease on screening, nine patients underwent laparoscopic cholecystectomy with one morbidity and no mortality or graft loss. Given the relative rarity of the critical events in this study (morbidity, mortality, and graft loss), the definitive statistical value of prescreening for gallbladder disease cannot be established. However, our results are suggestive of clinical value and thus we tentatively recommend ultrasound screening for gallbladder disease for all pretransplant patients and laparoscopic cholecystectomy for those identified to have gallbladder disease.