Myeloperoxidase cytochemical negativity: an unexpected but intrinsic property of blasts of all phases of chronic myeloid leukemia

Myeloperoxidase (MPO) cytochemical activity, recognized as a very important hallmark of myeloblasts, is generally negative in chronic myeloid leukemia (CML) blast crisis (BC). Because this finding is unexpected, being not in keeping with the myeloproliferative nature of CML, we tried to ascertain if MPO cytochemical negativity could be an intrinsic property of blasts of CML and hence present in the preblastic phases as well. Myeloperoxidase cytochemistry of peripheral blood blasts in 161 cases of CML, including 103 in chronic phase (CP) and 29 each in accelerated phase (AP) and BC, was assessed and compared with that of 30 cases of acute myeloid leukemia, AML-M2. Blasts of 97 (94.2%) of 103 cases of CP, 28 (96.6%) of 29 cases of AP, and 22 (75.9%) of 29 cases of BC were negative for MPO (<3% MPO-positive blasts). Compared with the strong MPO positivity, both in terms of intensity and proportion, in the AML-M2 cases, the positivity in the CML cases was generally weak and was seen in a small number of blasts (5–15%), except in one case of BC with 20% positive blasts. Absence or, at times, weak MPO cytochemical activity is an intrinsic property of blasts of all phases of CML, and use of the term myeloblast in CML should be understood to refer to a cell with this property. This also explains why MPO cytochemistry, despite its high reputation as a myeloid-lineage marker, generally does not help in CML BC. CML BC should therefore be considered as a possible diagnosis along with acute lymphoblastic leukemia, AML-M0, AML-M7, etc., in the setting of MPO-negative blasts. Similarity between MPO expression pattern in CML, i.e., negative in blasts and positive in the more mature cells, and that during maturation of normal myeloid series of cells shows the deranged myelopoiesis of CML to be undisturbed at least with respect to MPO expression. There is need for a more comprehensive study of blasts of preblastic phases.     

Total aorta replacement in takayasu arteritis presenting as mega aorta

We report a unique case of successful two-stage total aortic replacement from ascending aorta to aortic bifurcation that was done for extensive aneurysmal involvement of the aorta in Takayasu arteritis.     

Gastrointestinal disturbances in diabetes

Gastrointestinal disorders are common in patients with diabetes mellitus. As many as 75% of patients visiting diabetes clinics will report significant gastrointestinal (GI) symptoms. The symptom complex experienced may vary widely. Many patients go undiagnosed and undertreated. Patients with a history of retinopathy, nephropathy, or neuropathy should be presumed to have GI abnormalities until proven otherwise. The workup should start with a thorough patient history and appropriate laboratory, radiographic, and GI testing. In addition to pharmacologic therapy, glycemic control and dietary manipulation play an important role in managing GI disorders in people with diabetes.     

A heterologous prime-boost vaccination regimen using ORFF DNA and recombinant ORFF protein confers protective immunity against experimental visceral leishmaniasis

OBJECTIVE: We describe the effectiveness of a prime-boost vaccination regimen using the open-reading frame (ORFF) gene from the LD1 locus of Leishmania donovani. METHODS: A group of BALB/c mice was immunized with the plasmid carrying the gene for ORFF (F/pcDNA 3.1) and given a booster dose of either the same DNA vaccine or a vaccine with a recombinant ORFF (rORFF) protein. Another group of BALB/c mice was immunized and given a booster dose of the rORFF protein vaccine. The protective efficacies of these vaccine formulations were compared after challenge with L. donovani stationary-phase promastigotes. RESULTS: Mice given the prime-boost vaccination regimen had an enhanced reduction in parasite load (75%-80%), compared with that in mice given only the rORFF protein vaccine (45%-60%). However, the protective response induced in the prime-boost group was not more than that elicited in the DNA vaccine group. Immunization with only the rORFF protein vaccine did not induce the typical T helper response, whereas priming with the DNA vaccine resulted in enhanced production of immunoglobulin G2a and interferon- gamma . Furthermore, priming with the DNA vaccine also led to enhanced proliferation of splenocytes, suggesting subsequent expansion of antigen-specific T cells. CONCLUSIONS: The heterologous prime-boost vaccination strategy may be utilized for visceral leishmaniasis.     

Effect of Fe ion implantation on the thermoelectric properties and electronic structures of CoSb3 thin films

In the present study, thin films of single-phase CoSb₃ were deposited onto Si(100) substrates via pulsed laser deposition (PLD) method using a polycrystalline target of CoSb₃. These films were implanted by 120 keV Fe-ions with three different fluences: 1 × 10¹⁵, 2.5 × 10¹⁵ and 5 × 10¹⁵ ions per cm². All films were characterised by X-ray diffraction (XRD), Raman spectroscopy, atomic force microscopy (AFM), Rutherford backscattering (RBS) spectrometry and X-ray absorption spectroscopy (XAS). XRD data revealed that the ion implantation decreased the crystalline nature of these films, which are recovered after the rapid thermal annealing process. The Seebeck coefficient S vary with the fluences in the temperature range of 300 K to 420 K, and is found to be highest (i.e., 254 μV K⁻¹) at 420 K for the film implanted with 1 × 10¹⁵ ions per cm². The high S and low resistivity lead to the highest power factor for the film implanted with 1 × 10¹⁵ ions per cm² (i.e., 700 μW m⁻¹ K⁻²) at 420 K. The changing of the sign of S from negative for the pristine film to positive for the Fe-implanted samples confirm that the Fe ions are electrically active and act as electron acceptors by replacing the Co atoms. XAS measurements confirm that the Fe ions occupied the Co site in the cubic frame of the skutterudite and exist in the 3+ oxidation state in this structure.

The power factor for the Fe ion-implanted samples is greater than that of the pristine sample with a value of 700 mW m⁻¹ K⁻² at 420 K for the I_1E15A sample.     

Fungal Mycotic Aneurysm in a Case of Acute Lymphoblastic Leukemia

Chronic graft versus host disease (cGVHD) is a common late complication of allogenic hematopoietic stem cell transplant (HSCT). We analyzed risk factors, pattern and long term transplant outcomes of cGVHD at a tertiary cancer centre. Seventy-seven consecutive patients who underwent HSCT for acute leukemia were included. Forty (52 %) patients developed cGVHD; 24 (60 %) extensive stage while 16 (40 %) limited stage. Oral cavity was the commonest site of involvement (25 patients) followed by liver, skin and lung. We found that female donor to male recipient transplant and diagnosis of acute lymphoblastic leukemia (ALL) were the only factors associated with increased risk of cGVHD. The incidence of leukemia relapse was 18 % in patients who developed cGVHD compared to 51 % in those who did not (P = 0.002). Four year overall survival and relapse free survival (RFS) were 62 and 46 % in patients who developed cGVHD compared to 29 % (P < 0.001) and 29 % (P < 0.001) in patients who did not develop cGVHD, respectively. We conclude that cGVHD is more common in male patients with female donors and in patients transplanted for ALL. Oral cavity is the commonest site of cGVHD in our patients and transplant related survival outcomes are superior in patients who develop cGVHD.     

Sequential Treatment of Arsenic Trioxide Followed by All Trans Retinoic Acid with Anthracyclines has Excellent Long-Term Cure in Acute Promyelocytic Leukemia

Acute promyelocytic leukemia (APL) remains the most curable myeloid leukemia made feasible through effective use of two differentiating agents, all trans retinoic acid (ATRA) and arsenic trioxide (ATO) with or without chemotherapy (CT). However, early morbidity and mortality remains a problem. With the objective of reducing early death a strategy of sequential induction ATO followed by consolidation ATRA in combination with CT was adopted by our group. The long-term outcomes of patient of APL treated on this sequential approach at our center was analyzed. In this retrospective analysis of prospectively maintained database consecutive adult patients with APL irrespective of their Sanz risk group were treated using a protocol of ATO (10 mg IV infusion over 3 h daily for 45 days) in the first phase followed by ATRA (45 mg/m² for 60 days) in combination with Daunorubicin (60 mg/m² for 3 days × 3 cycles) in second phase. All patients received maintenance ATRA (45 m/m² for 15 days every 3 months) for a period of 18 months in phase 3. Patients were monitored for cytogenetic and molecular responses after phase 1 and 2. All patients were followed up for toxicity, event free and overall survival. 131 consecutive patients were treated in this study. At a median follow up of 60 months, 84.81% patients are alive with an overall event free survival (EFS) of 77.82%. Sanz low risk patients fared better (85%) versus intermediate and high-risk patients who had a 76% EFS. Proportion of patients alive at last follow up were 100% in Sanz low risk group and 82% in intermediate and high-risk group. The sequential schedule showed excellent tolerance and toxicity profile when treating newly diagnosed APL. The long-term follow-up data shows comparable if not better survival compared with the published real-world data and this has been consistent across all risk group.     

Variable expression of coxsackie-adenovirus receptor in thyroid tumors: implications for adenoviral gene therapy.

Adenoviral gene therapy represents a novel approach for the treatment of aggressive thyroid carcinomas. Both coxsackie-adenovirus receptor (CAR) and integrins have been shown to be the major determinants for adenoviral infectivity in many types of cancer cells, yet conflicting results have been reported. In this report we examine these factors mediating adenoviral infection in thyroid cells and to evaluate CAR expression in various types of thyroid cancer. We found that neither expression levels of CAR nor integrins are solely predictive of adenoviral infectivity in thyroid cells. However, the absence of CAR was associated with poor adenoviral infectivity in immortalized rat FRTL-5 cells. Moreover, preincubation with alpha-CAR antibody decreased infectivity in FTC 238 cells, a human thyroid tumor line. These results indicate that CAR does play a role in adenoviral infection of thyroid cells. Immunohistochemical analysis revealed that CAR is expressed at the cell surface in the majority of malignant thyroid tumors. We further show that adenoviral infectivity in some thyroid cancer cells can be improved by poly-L-lysine. Our study warrants a functional method to evaluate adenoviral infectivity should be developed and instituted prior to clinical trials of adenoviral gene therapy in patients with advanced thyroid cancer.     

Knowledge, attitude and practices towards HIV among nurses in a tertiary care teaching hospital: two decades after the discovery

Accidental transmission of HIV infection to health care workers during occupational exposure is a real threat today. The first such case in India has been documented by NACO recently. Adequate knowledge about the disease and practice of safety measures are our best bet to reduce such transmission. A survey was carried out amongst over 500 nurses in a tertiary care referral hospital in Delhi to assess their knowledge, attitude and practices towards HIV/AIDS. While overall knowledge was satisfactory, there were gaping holes in vital areas. The conversion of their theoretical knowledge into safe practices was shockingly poor. It was due to attitude problems as much as inadequate supplies. High incidence of accidental exposures in the near past and complete ignorance of post-exposure prophylaxis guidelines was another highlight of this study. Despite tremendous efforts put in by the Government as well as various Non-Governmental Organizations, we are completely ill equipped to fight the menace of occupational HIV transmission. In order to fight this menace, "safe practices" have to be made a "way of life" for HCWs. Our health care planners need to take note of it and our teaching and training programmes need complete re-orientation to achieve this goal.     

Cross-cultural adaption,reliability and validity of an Indian (Tamil) version for the Shoulder Pain and Disability Index

The objective of the study was to cross-culturally adapt the Shoulder Pain and Disability Index (SPADI) into a regional Indian language (Tamil) and to test the reliability and linguistic validity of the index in Tamil-speaking Indian participants. Cross-cultural adaptation and psychometric testing of SPADI was undertaken at the Outpatient Physiotherapy Department of the Sri Ramachandra University Hospital in Chennai, India. The Test-retest reliability was quantified using the interclass correlation coefficient (ICC) and Cronbach alpha was calculated to assess internal consistency of the Tamil questionnaire. The construct validity was assessed using Spearman rank correlation coefficients. The reliability of the total Tamil SPADI and its subsets (Intraclass correlation coefficient >0.90) were found to be higher than that of the English SPADI and the German SPADI in this population. The internal consistency of the Tamil SPADI (Cronbach's alpha >0.95) was slightly higher than the English and the German versions. Thus, the cross-culturally adapted version of the English SPADI into a regional Indian language (Tamil) is easy to use and is a reliable and valid measure of shoulder pain and disability in the Tamil speaking population.