Interactions Between Cytomegalovirus, Human Herpesvirus-6, and the Recurrence of Hepatitis C After Liver Transplantation

Recurrence of hepatitis C (HCV) following liver transplantation is common. Herpesvirus reactivation following transplant may have an immunomodulatory effect resulting in increased HCV replication. We studied whether cytomegalovirus (CMV) and human herpesvirus-6 (HHV-6) may be associated with HCV recurrence and viral load after transplant. We prospectively followed 66 HCV liver-transplant recipients with serial viral load testing for CMV and HHV-6. Infection and viral load were correlated with the development of biopsy-proven HCV recurrence and HCV viral loads. Histologic recurrence of HCV occurred in 41/66 (62.1%) patients. In the primary analysis, CMV infection and disease, and HHV-6 infection were not associated with HCV recurrence. Peak CMV and HHV-6 viral loads were not significantly different in patients with and without recurrence. No correlation was observed between HCV viral loads at 1 and 3 months post-transplant and peak HHV-6 or CMV viral loads. In a subgroup analysis, HHV-6 infection was associated with the development of more severe recurrence (hepatitis and/or fibrosis score > or = 2) (p = 0.01). Also, fibrosis scores at last follow up were higher in patients with CMV disease (1.67 vs. 0.56; p = 0.016) and in patients with HHV-6 infection (1.18 vs. 0.55; p = 0.031). In conclusion, HHV-6 and CMV infection and viral load were not associated with increased overall rates of HCV recurrence or HCV viral load after liver transplantation but may be associated with more severe forms of recurrence.     

Selection of sites for slit skin smears in untreated and treated leprosy patients

A total of 1000 slit-skin smears were taken from multiple sites (both ear lobules, right elbow, dorsal aspect of middle phalanx of the left finger, and dorsum of middle phalanx of the right foot) from 558 leprosy patients. There were 319 sets (1595 smears) from untreated patients and 681 sets (3405 smears) from the treated group. The duration of treatment varied from 6 months (multidrug therapy) to 7 years (dapsone monotherapy). The ear lobules gave significantly higher values for the bacterial index (BI) compared to toes and fingers in the untreated group. The morphological index (MI) was also significantly higher from the ear lobules compared to toes, elbows, and fingers. In five patients from the untreated group, bacilli were found in some other sites when the earlobes did not reveal any. In the treated group, all sites yielded similar BI and MI values, the figures being lowest from elbows and toes but not different statistically. In 20 long-treated patients, bacilli were detected at sites other than the ear lobules. In 28 patients, sites other than the ear lobules gave a higher MI and in 20 patients, solid bacilli were seen at sites other than the ear lobules.     

Dopa-responsive parkinsonism secondary to right temporal lobe haemorrahage.

A 46-year-old man developed a symmetrical parkinsonian syndrome 7 weeks after large right temporal intracerebral haemorrhage resulting from a ruptured arteriovenous malformation. His signs included bradykinesia, rigidity, start hesitation, and poor postural reflexes, without a resting tremor. He also had signs of a Parinaud's syndrome. Computed tomography and magnetic resonance imaging of the brain demonstrated changes in the right temporal lobe associated with the haemorrhage but no abnormality of the basal ganglia or midbrain. Levodopa therapy produced a dramatic improvement within a few days of commencement. We postulate that the parkinsonism resulted from midbrain compression secondary to transtentorial herniation. Although parkinsonism is a rare complication of lobar intracerebral haemorrhage, it is important to recognise as it may be potentially treatable.     

Prognostic relevance of DNA ploidy in rhabdomyosarcomas and other sarcomas of childhood.

A study of DNA content by flow cytometry revealed a significant difference between rhabdomyosarcomas, which were mainly non-diploid, and other sarcomas of children which were mainly diploid (p = 0.01). There was no association between DNA ploidy and survival or aggressive behaviour of the tumour as indicated for example by advanced clinical stage or unfavourable histology. While DNA ploidy correlated with age, it did not correlate with any other clinical characteristic. The apparent lack of prognostic value of DNA content may have been masked by some high CV values and overridden by the effect of chemotherapy which was the most significant variable in determining a patient's survival (p = 0.00005).     

Bacteriophage typing in Salmonella bareilly.

A total of 675 strains of Salmonella bareilly received from different parts of India and France during 1959-92 were phage typed using six bacteriophages. Overall typability achieved was 90.8% with 23 distinct phage types excluding a group of untypable strains. Phage types have been defined in octal code. Simpson''s coefficient was applied for diversity index having a value of 0.839. This system was found to be reproducible, stable and epidemiologically useful.     

Psychological responses to thermal stress in a glass bangle factory.

Behavioural studies were conducted on a random sample of 38 glass bangle workers engaged in various occupations and exposed to high ambient temperature (38.2 +/- 3.4 degrees C) and radiant heat (46.2 +/- 5.1 degrees C) during their work in the glass bangle industries at Firozabad, India. Twenty-two control subjects of similar age and socio-economic status unexposed to heat during their work were also studied for comparison. The digit span test, digit symbol test, Bourdon-Wiersma vigilance test, flicker fusion test and Maudsley personality inventory (MPI) were used to assess the behavioural changes induced by the existing heat stress. The mean scores of immediate memory were much lower in the exposed population than in the controls thereby indicating impairment of immediate memory in the study group. The visuo-motor coordination and vigilance were also significantly affected. Visual perception showed a downward trend among the glass bangle workers, although the MPI test indicated no personality changes.     

Dengue fever presenting with acute colitis.

Gastrointestinal manifestations of dengue fever are mainly in the form of bleeding or liver function abnormalities. Dengue fever presenting as acute colitis-like picture is not reported to date. We report a 50-year-old man with dengue fever presenting with lower gastrointestinal bleeding and colonoscopic features of acute inflammatory colitis.