Diffuse nodular hyperplasia of Brunner's gland presenting as upper gastrointestinal haemorrhage

Brunner's gland adenoma is a very unusual cause of upper gastrointestinal bleeding. We report a 16-year-old boy who presented with upper gastrointestinal haemorrhage from diffuse nodular hyperplasia of Brunner's gland without involvement of the first part of the duodenum. The patient was managed conservatively during his hospital stay, and was doing well without any recurrence after nine months of follow-up.     

Specific small-molecule activator of Aurora kinase A induces autophosphorylation in a cell-free system

Aurora kinases are essential for chromosomal segregation and cell division and thereby important for maintaining the proper genomic integrity. There are three classes of aurora kinases in humans: A, B, and C. Aurora kinase A is frequently overexpressed in various cancers. The link of the overexpression and tumorigenesis is yet to be understood. By employing virtual screening, we have found that anacardic acid, a pentadecane aliphatic chain containing hydroxylcarboxylic acid, from cashew nut shell liquid could be docked in Aurora kinases A and B. Remarkably, we found that anacardic acid could potently activate the Aurora kinase A mediated phosphorylation of histone H3, but at a similar concentration the activity of aurora kinase B remained unaffected in vitro. Mechanistically, anacardic acid induces the structural changes and also the autophosphorylation of the aurora kinase A to enhance the enzyme activity. This data thus indicate anacardic acid as the first small-molecule activator of Aurora kinase, which could be highly useful for probing the function of hyperactive (overexpressed) Aurora kinase A.     

alpha-Amino acid derivatives as proton pump inhibitors and potent anti-ulcer agents

In a program to identify new anti-ulcer compounds, a series of N-acyl derivatives of alpha-amino acids were screened for their in vitro H(+)/K(+) ATPase inhibitory activity, and in vivo efficacy in Pylorus ligation model. 3D-QSAR studies were carried out and a representative compound 13 was studied for the nature of its proton pump inhibition.     

Photorefractive keratectomy (PRK) Prediction,Examination, tReatment,Follow-up,Evaluation, Chronic Treatment (PERFECT) protocol - A new algorithmic approach for managing post PRK haze

Purpose:The aim of this study was to discuss the possible risk factors predisposing to post photorefractive keratectomy (PRK) haze formation and develop and validate a risk scoring system, so that this could be applied to our clinical practice as an algorithmic approach.Methods:Study was divided into 2 arms, in the retrospective arm we looked at 238 eyes of patients undergoing PRK where certain presumed risk factors from literature and clinical experience were identified and statistical significance of association was studied in the development of corneal haze. The risk scoring system was applied to the 450 eyes in the prospective arm for validation. This was then used to formulate an algorithmic approach to manage post-PRK haze.Results:22 out of 238 eyes in the retrospective arm developed haze where risk factors such as contact lens intolerance, altered tear film break up time, meibomian gland drop out and vitamin d levels were significantly associated with post-PRK haze (p < 0.05) and these factors were identified in the prospective arm. Treatment of these modifiable factors led to a significant reduction in post-PRK haze.Conclusion:Thus identifying and treating risk factors of haze in patients undergoing PRK could improve surgical outcomes and patient satisfaction.     

Epitope mapping of functional domains of human factor Va with human and murine monoclonal antibodies. Evidence for the interaction of heavy chain with factor Xa and calcium

We have purified a unique neutralizing IgG1, kappa monoclonal antibody (MAb) against factor V (F-V) from a patient's plasma. This MAb (H2) demonstrated specificity for human F-V heavy chain (D), mol wt 105,000. Using an enzyme-linked immunosorbent assay (ELISA) we assessed the competitive binding to F-Va of H2, H1 (human MAb directed to light chain, F1F2), and two murine MAbs, B38 (to F1F2) and B10 (to activation peptide C1). All four antibodies are of high affinity with KD varying from 0.17 to 1.17 X 10(-10) mol/L. They recognized distinct epitopes in F-V. F-Xa competed in a concentration-dependent fashion for binding of H1, H2, and B38 but not B10 to F-V/Va in the absence of phospholipids or platelets. Thus both F1F2 and D polypeptides of F-Va but not C1 interacted with F-Xa. All MAbs bound to F-V/Va in the absence of Ca++. However, free Ca++ (0.1 to 4.0 mmol/L) increased the amount of H1 and H2 bound to factor V/Va, 1.65-fold and 3.65-fold, respectively but had little effect on the binding of either murine MAbs. Prothrombin (20 micrograms/mL to 400 micrograms/mL) in the absence of phospholipid did not inhibit the binding of MAbs. These studies provide evidence for the first time for a direct interaction between human F-Va heavy chain and F-Xa and Ca++ and for the direct binding of F-Xa to F-Va in the absence of phospholipids or platelets and enhance our understanding of functional F-V domains.     

Hepatitis B e Antigen Negative Chronic Hepatitis in Indian Patients : A Reality

Background

Hepatitis B e antigen negative chronic hepatitis (e⁻ CHB) with detectable levels of hepatitis B virus DNA (HBV DNA) in serum has been reported in cases from Asia. This study was undertaken to find out prevalence e⁻CHB and to correlate its presence with the clinical status and severity of the illness in cases of chronic liver disease in India.

Methods

All patients of infective hepatitis, who were hepatitis B surface antigen (HBsAg) positive by enzyme-linked immunosorbent assay (ELISA), were evaluated with liver function tests and HBeAg and antiHBe antibody studies. Polymerase chain reaction (PCR) test was carried out to detect HBV DNA qualitatively.

Result

Out of 2064 samples tested by ELISA, 429 (20.78 %) were HBsAg positive. HBV DNA (qualitative) was performed on all 429 patients and 74 (17.2%) were HBV DNA positive. Of these only 42 (56.75 %) tested positive for HBeAg. Overall, 8.3 % of HBeAg negative patients (32/384) were viraemic with evidence of chronic liver disease/clinical cirrhosis and alteration of transaminase levels, while three cases (0.84 %) HBeAg positive cases did not show presence of HBV DNA.

Conclusion

This study shows e⁻CHB prevalence rate of 8.3% in patients with HBV infection in India. Since HBeAg negative patients had detectable levels of HBV DNA as seen in HBeAg positive patients, benefit of antiviral therapy should be given to them. Population studies on e⁻ CHB cases are needed to determine its true prevalence, natural course and response to therapy.Key Words: Chronic hepatitis, Hepatitis B virus, Hepatitis B e antigen negative     

An Outbreak of Food Poisoning in a Military Establishment

Background

An outbreak of food poisoning in a military establishment mess was investigated and remedial measures suggested.

Methods

A total of 391 persons had consumed meals in the mess on the day of the outbreak. A detailed food history was taken from available persons and the attack rates of each specific food items were calculated with the relative risks.

Results

Of the 391 persons who had consumed meals at the mess, 123 were affected giving an overall attack rate of 31.5%. Majority of the cases had loose motions, fever, pain abdomen and vomiting. The maximum attack rate (65.1%) was for those who had eaten chicken preparation. The relative risk was also highest for those who had eaten chicken at lunch on the day of the outbreak (RR — 33.21, 95% CI 8.39 to 131.53). The mean incubation period was 19.73 hours (range 6 – 57 hours). The median incubation period was 18 hours. Bacteriological confirmation was not successful.

Conclusion

The chicken dish was the epidemiologically incriminating food item responsible for the outbreak. Clinical and epidemiological features were suggestive of salmonella food poisoning. However, same could not be confirmed bacteriologically.Key Words: Food poisoning, Military establishment     

Outbreak of Rubella Among Cadets in an Academy

Background

Rubella is traditionally considered a childhood disease, but has the potential to cause outbreaks in closed community of young adults. The present paper describes one such outbreak in a military training establishment.

Method

The cases of rubella outbreak were identified by clinical features (fever, rash and lymphadenopathy) and confirmed by detection of high titre of anti-rubella IgM antibodies by enzyme-linked immunosorbent assay. Initial serum samples were also tested for antibodies against measles, scrub typhus and dengue. Salient epidemiological features of the outbreak were studied.

Result

163 cadets were admitted in the local military hospital within two months. The cases presented with fever, coryza, lymphadenopathy and maculopapular rash. 117 (71.78%) of the samples showed presence of anti-rubella IgM antibodies.

Conclusion

Rubella outbreaks in military communities have the potential to adversely affect military training/operations. The need for administration of vaccination against rubella in such population may be reviewed.Key Words: Rubella outbreak, Military academy     

Unilateral lower limb oedema in pregnancy

A 21 years old lady was admitted with severe pain and swelling of left lower limb in a pregnancy of 34 weeks of period of gestation. On examination there was pitting oedema of the whole left lower limb with extreme tenderness. Doppler USG of left femoral vein showed a thrombus in the process of recanalisation and no significant flow was demonstrated inside the lumen and USG for foetoplacental profile showed a single live foetus of gestational age 34 weeks. The case was diagnosed as deep venous thrombosis in pregnancy. She was treated with heparin injection 5000 unit subcutaneously twice daily throughout pregnancy along with antibiotics. In spite of proper management she developed extensive ulceration in left lower limb. She delivered normally a healty male child after induction with oxytocin dirp. The postpartum period was uneventful. Throughout this period heparin was continued and she was referred to surgery department for skin grafting.