Gain of chromosome arm 1q in atypical meningioma correlates with shorter progression-free survival

M. Jansen, G. Mohapatra, R. A. Betensky, C. Keohane and D. N. Louis (2012) Neuropathology and Applied Neurobiology 38, 213–219 Gain of chromosome arm 1q in atypical meningioma correlates with shorter progression‐free survival Aims: Atypical (World Health Organization grade II) meningiomas have moderately high recurrence rates; even for completely resected tumours, approximately one‐third will recur. Post‐operative radiotherapy may aid local control and improve survival, but carries the risk of side effects. More accurate prediction of recurrence risk is therefore needed for patients with atypical meningioma. Previously, we used high‐resolution array comparative genomic hybridization to identify genetic variations in 47 primary atypical meningiomas and found that approximately 60% of tumours show gain of 1q at 1q25.1 and 1q25.3 to 1q32.1 and that 1q gain appeared to correlate with shorter progression‐free survival. This study aimed to validate and extend these findings in an independent sample. Methods: Eighty‐six completely resected atypical meningiomas (with 25 recurrences) from two neurosurgical centres in Ireland were identified and clinical follow‐up was obtained. Utilizing a dual‐colour interphase fluorescence in situ hybridization assay, 1q gain was assessed using Bacterial Artificial Chromosome probes directed against 1q25.1 and 1q32.1. Results: The results confirm the high prevalence of 1q gain at these loci in atypical meningiomas. We further show that gain at 1q32.1 and age each correlate with progression‐free survival in patients who have undergone complete surgical resection of atypical meningiomas. Conclusions: These independent findings suggest that assessment of 1q copy number status can add clinically useful information for the management of patients with atypical meningiomas.     

Atypical presentation of bilateral supplemental maxillary central incisors with unusual talon cusp

Delayed eruption of maxillary permanent central incisors in a child poses a distressing esthetic quandary to parents, by virtue of its location in the dental architecture. Well-aligned anterior teeth add confidence to smile and have enhanced self-esteem, which is critical even in early life. Impaction of the maxillary central incisors compared to third molars or the canines is less reported; bilateral supplemental maxillary central incisors related to impacted permanent maxillary central incisors are rare and one of the supplemental central incisors showing unusual talon is still infrequent. A case of impacted maxillary permanent central incisors related to supplemental maxillary central incisors, with one of them showing an unusual talon cusp, is presented.     

Neurocysticercosis: Acute presentation and intensive care management of two cases

Neurocysticercosis (NCC), a common helminthic infestation in developing countries, may cause acquired epilepsy and neurological morbidities. Acute symptomatic seizure is the most common manifestation. The other clinical conditions include headache, hydrocephalus, chronic meningitis, focal neurological deficits, and psychological disorders. Altered sensorium and raised intracranial pressure (ICP) may require ventilatory support in an intensive care unit (ICU). Definitive diagnosis is made by identification of parasites in tissues or by a radiological demonstration of the scolex in cystic lesions. Antiepileptic drugs are used to control seizures after NCC. Steroids are generally administered along with antihelminthics, in order to control the edema and intracranial hypertension that may occur as a result of antiparasitic medications. In patients with intracranial hypertension, the priority is to manage the ICP before considering other treatment options. Antiparasitic drug treatment is never the mainstay of treatment, especially in the setting of elevated ICP. Here, we present the ICU management of two such cases.     

Reinforcement of Endocrine Surgery Training: Impact of Telemedicine Technology in a Developing Country Context

Aims and Objectives Technology-based outreach programs for knowledge sharing and skill development using telemedicine is a novel approach to developing subspecialties in regions where there is a lack of specialists and dedicated departments. Endocrine surgery is one such emerging subspecialty. There are few dedicated surgeons and centers even in the developed world. India has only one such center. The aim of this study was to assess the feasibility and impact of telemedicine on the reinforcement of endocrine surgery training at distant places to develop this subspecialty in a developing country such as India. Material and Methods Two faculty members from the General Surgery Department at SCB Medical College in Cuttack, Orissa, India registered at Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow for a short 3-month training course in endocrine surgery in 1998 and thereafter consulted through telephone calls and e-mail when required. Telemedicine-based mentoring was introduced in 2001 as a reinforcement method for continuing training and skills development. Various training modules were used, including tele-consultation, case presentation, treatment planning, tele-radiology, tele-pathology, and tele-continuing medical education (CME) programs and workshops. The outcome was assessed in terms of the increase in the number of patients with endocrine disorders seen and operated on by trainees and the complication rates. Results A total of 70 telemedicine sessions were held between 2001 and 2005. They included tele-education and surgical treatment planning (n = 44), tele-consultation including tele-pathology and tele-radiology (n = 26), and tele-surgical conferences/CME (n = 6). The number of endocrine surgical cases performed by trainees after training (phase II) increased significantly compared to those before training (phase I), with a further increase after starting telemedicine-enabled mentoring (phase III). Most of the patients operated on by the trainees had thyroid problems, although these surgeons started operating on a few patients with parathyroid and adrenal disorders as well. The morbidity figures for the thyroidectomy operations (including total thyroidectomy) were comparable to those at the training institution. Conclusion The concept of training a group of motivated general surgeons to practice safe endocrine surgery at a remote center via telemedicine-aided reinforcement of their training is thus feasible. This is particularly true in the case of thyroidectomy operations, which constitute the major workload of endocrine surgery in our country. The same program might be applicable to the development of other medical subspecialties in a developing country as well.     

Inflammatory bowel disease in children: current trends

Once considered rare in the East, inflammatory bowel disease (IBD) is now recognized to be an emerging entity in that region. East or West, the clinical features of and treatment options for IBD are the same, but it is possible that the exact pathogeneses or the initiating events differ. In this review, existing knowledge of IBD and new discoveries in the epidemiology, genetics and treatment of IBD are discussed in detail. The diagnosis and management of IBD in children has changed dramatically over the last decade, mainly due to increased awareness, the availability of newer diagnostic modalities such as MRI and video capsule endoscopy, and newer, more powerful treatments such as biologics. It is hoped that the combination of innovative research and advances in drug discoveries will change the natural history of IBD and make a major difference in children who are suffering from this unfortunate lifelong chronic inflammatory disorder.     

Fate of Fipronil and its Metabolites in/on Grape Leaves, Berries and Soil Under Semi Arid Tropical Climatic Conditions

Fate of fipronil and its major metabolites fipronil sulfide (MB 45950), fipronil-desulfinyl (MB 46513) and fipronil sulfone (MB 46136) were studied in/on grape leaves, berries and soil. As initial residue deposits on the leaves the major component was that of fipronil, while all the 3 metabolites were also present. Among metabolites residues of MB 46513 was highest followed by MB 46136 and MB 45950. In leaves fipronil degraded faster than its metabolites. The residues of fipronil in leaves degraded at the half-life of 9.6 and 18.3 days and that of total fipronil (sum of fipronil and its metabolites) at 13.6 and 20 days, from treatment at recommended and double the recommended dose, respectively. At the time of harvest in leaves, grape berries and soil residues of fipronil and all its metabolites were below the quantifiable limit of 0.01 mg kg^?1.     

Derivation of rough attenuated variants from smooth virulent Aeromonas hydrophila and their immunogenicity in fish

Aeromonas hydrophila is a Gram-negative bacteria associated with many disease conditions of aquatic animals. Two rough attenuated variants were derived from two smooth virulent types of this bacterium by continuous passage separately in laboratory over a period of 8 years in brain–heart infusion agar. These variants were checked to be rough lipopolysaccharides (LPS) types and attenuated since they neither produced any disease nor mortality in the injected fishes. The immunogenic potential of these variants remained unaltered as compared to parent smooth types and fish immunized with these variants resisted the infection and mortality upon cross challenge. Because of their intact immunogenic potential and loss of virulence, they may be used as candidates for fish immunization.     

Detection of antibodies specific for foot-and-mouth disease virus infection using indirect ELISA based on recombinant nonstructural protein 2B

Foot-and-mouth disease (FMD) is a highly contagious viral disease of transboundary importance. In India, since the launch of the FMD control programme, there has been a substantial increase in the vaccinated bovine population. In this scenario, there is a need for additional locally developed non-structural protein (NSP)-based immnoassays for efficient identification of FMD virus (FMDV)-infected animals in the vaccinated population. The 2B NSP of FMDV, lacking the transmembrane domain (Δ2B), was expressed successfully in a prokaryotic system, and an indirect ELISA (I-ELISA) was developed and validated in this study. The diagnostic sensitivity and specificity of the Δ2B I-ELISA were found to be 95.3 % and 94.6 %, respectively. In experimentally infected cattle, the assay could consistently detect Δ2B-NSP-specific antibodies from 10 to approximately 400 days postinfection. The assay was further validated with bovine serum samples collected randomly from different parts of the country. The performance of the Δ2B I-ELISA was compared with the in-house r3AB3 I-ELISA, and the overall concordance in test results was found to be 86.49 %. The Δ2B I-ELISA could be useful as a screening or confirmatory assay in the surveillance of FMD irrespective of vaccination.     

Diagnostic potential of recombinant nonstructural protein 3B to detect antibodies induced by foot-and-mouth disease virus infection in bovines

Detection of antibodies to nonstructural proteins (NSP) of foot-and-mouth disease virus is the preferred diagnostic method to differentiate infected from vaccinated animals. In India, an endemic region practising preventive biannual vaccination, 3AB3 indirect ELISA (r3AB3 I-ELISA) has been employed as the primary screening test for serosurveillance. However, because of the variability observed in the immune response to the NSPs, the likelihood of detecting or confirming an infected animal is increased if an antibody profile against multiple NSPs is considered for diagnosis. In this study, all three copies of NSP 3B were expressed in a prokaryotic system to develop an indirect ELISA (r3B I-ELISA). At the decided cutoff of 40 percent positivity, the diagnostic sensitivity and specificity of the r3B I-ELISA were estimated to be 92.1 % (95 % CI: 89.0–94.5) and 98.1 % (95 % CI: 96.9–98.8), respectively, as compared to 97.04 % and 95.04 % for r3AB3 I-ELISA. Although r3B I-ELISA displayed lower sensitivity compared to the screening assay, which could possibly be attributed to additional relevant B-cell epitopes in the carboxy-terminal half of the 3A protein, the former achieved considerably higher specificity on repeatedly vaccinated animals. NSP antibodies could be detected from 10 to as late as 998 days postinfection in experimental calves. Substantial agreement in the test results (90.6 %) was found between the two ELISAs. The r3B I-ELISA, when used in conjunction with the r3AB3 I-ELISA as an integrated system, can potentially augment the efficiency and confidence of detection of infected herds against the backdrop of intensive vaccination.