Childhood lichen planus: a study of 87 cases

AIMS: We undertook this study to analyze the clinical profile of childhood lichen planus (LP) prevailing in north India, and to highlight differences from and similarities with adult LP. METHODS: Clinical records of children with LP, who attended the Pediatric Dermatology Clinic, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India, from July 1988 to December 2000, were analyzed. RESULTS: Eighty-seven patients with LP were examined during a 12.5-year period of observation. These patients formed 2.5% of the total number of pediatric dermatology patients and 0.6% of the total number of new dermatology outpatients. The male : female ratio was 1.1 : 1. The age at onset was between 8 months and 12 years (mean, 7.1 years). Classical LP was observed in 53 (60.9%) patients, followed by actinic LP in 10 (11.5%), and lichen planus hypertrophicus (LPH) and linear LP in eight (9.2%) each. Other forms seen were eruptive, follicular, lichen planopilaris, atrophic, and bullous LP. The involvement of skin alone was observed in 75 (86.2%) children and mucosa alone only in one (1.1%) child. Concomitant skin and mucosal involvement was seen at the time of presentation in four patients, while mucosal involvement occurred later during the course of the disease in seven patients. Lesions appeared earlier in boys than in girls. CONCLUSIONS: The natural history of LP in children was essentially similar to that in adults. Unusual features, such as involvement of the palms and soles and upper eyelids, were observed. Actinic LP, mimicking melasma, as reported in adult women, also seems to occur in children.     

Rising incidence of genital herpes over two decades in a sexually transmitted disease clinic in north India

Genital herpes, which was considered to be a minor sexually transmitted disease (STD) in the past in developing countries, is rapidly increasing; in contrast, bacterial STDs are declining. This changing trend of various STDs prompted us to analyze our data retrospectively to see whether a similar change is occurring in this part of India as well. The records of sexually transmitted diseases (STDs) clinic attendees from January 1977 to December 2000 were analyzed. The demographic profile of patients with genital herpes was also considered for analysis. STDs were diagnosed clinically and by appropriate laboratory tests wherever applicable. VDRL test was done in all patients, and HIV antibody detection was performed from 1987 onwards. The incidences of chancroid, donovanosis, and gonorrhea were 12.2%, 6.3%, and 16.9%, respectively, from January 1977 to December 1985. The figures for the same decreased to 2.5%, 0.9%, and 2.3%, respectively, from January 1993 to December 2000. The decreasing incidence of the above bacterial STDs is statistically significant (p<0.001). However, there was an approximately two-fold increase in the incidence of genital herpes in recent years (20.5%) in comparison to the figures from the late 70s (11.4%). Molluscum contagiosum also showed an upward trend (1% in 1977-85 vs. 9.8% in 1993-2000). Condylomata accuminata remained almost unchanged (21.4% in 1977-85 vs. 20% in 1993-2000). To conclude, a significant increase in the number of viral STDs and a decline in the bacterial diseases were observed in recent years in comparison to the figures from the late 70s. This may be due to awareness of HIV, success of control programs, syndromic management of STDs, and adoption of safer sexual practices, which prevent bacterial STDs more efficiently than viral ones.     

Molecular epidemiology of human picobirnaviruses among children of a slum community in Kolkata, India

Picobirnaviruses are a group of unclassified, non-enveloped, small spherical viruses, 35-41 nm in diameter without any apparent surface morphology. They have characteristic bisegmented double stranded RNA genome of two types namely large profile (2.3-2.6 kbp for the larger and 1.5-1.9 kbp for the smaller segment, respectively) or small profile (1.75 and 1.55 kbp for segments 1 and 2, respectively). Human picobirnaviruses (n=12 positives; 2/56 diarrhoeic children and 10/607 non-diarrhoeic children) with large (n=11) or small (n=1) genome pattern were observed in faecal specimens of children from a slum community by silver stained PAGE gels. Faecal specimen from four asymptomatic cases (P597_02_IND, K135_02_IND, A373_03_IND, A356_03_IND) and one diarrhoeic case (K135_03_IND) had genogroup I picobirnaviruses (1-CHN-97 like) showing amplicons within the 201 bp region, with primers PicoB25-PicoB43, targeting the conserved domain of RNA-dependent RNA polymerase (RdRp) gene. It was interesting to note that only the PBV strain P597_02_IND from Kolkata with large genome was closely related to a reported strain (similarity with 2-GA-91 from USA was 87% at the nucleotide level and 90% at the amino acid level). Sequence analysis showed three conserved amino acid domains as well as a highly conserved D-S-D motif, characteristic of RNA-dependent RNA polymerase gene of bisegmented, double stranded RNA viruses. Sequence data of the picobirnavirus A356_03_IND indicated strong heterogeneity with all other picobirnavirus strains sequenced till date. After nearly a decade a genogroup II picobirnavirus strain (R227_03_IND) was isolated from a diarrhoea case in the community, with small genome profile and amplified with specific primers PicoB23-PicoB24; but the sequence data showed that it was divergent from the hitherto reported prototype strain 4-GA-91 of genogroup II human picobirnaviruses.     

Hemiagenesis of the thyroid associated with chronic lymphocytic thyroiditis

The authors report a case of hemiagenesis of the left thyroid lobe indicated on Tc-99m pertechnetate scan and later confirmed on ultrasonography. The patient was clinically hypothyroid with a right-sided goiter. The cytopathologic diagnosis was made by fine-needle aspiration cytologic analysis, which indicated chronic lymphocytic thyroiditis in the right lobe of the thyroid gland. Later the patient's condition was stabilized with thyroxine replacement therapy. The association of hemiagenesis of the thyroid with chronic lymphocytic thyroiditis has not been reported in the literature.     

High dose rate gynecological applications--radiobiological considerations based on the alpha-beta model.

We compare the relative efficacy of high dose rate (HDR) and low dose rate (LDR) irradiation in gynecological implants, using formulations based on the linear-quadratic (alpha-beta) model. We consider both acute reaction and late effect as endpoints in evaluating equivalence for HDR and LDR treatments, at Point A (as defined in the text) and at other locations. We define a therapeutic factor gamma as an index for relative efficacy, with gamma > 1 indicating a gain in substituting HDR for LDR. It is found that gamma < 1 for most clinical situations, although a modest decrease (of about 15%) in dose to critical organs for HDR would raise gamma above unity.     

Iron oxide nanoparticles for sustained delivery of anticancer agents

We have developed a novel water-dispersible oleic acid (OA)-Pluronic-coated iron oxide magnetic nanoparticle formulation that can be loaded easily with high doses of water-insoluble anticancer agents. Drug partitions into the OA shell surrounding iron oxide nanoparticles, and the Pluronic that anchors at the OA-water interface confers aqueous dispersity to the formulation. Neither the formulation components nor the drug loading affected the magnetic properties of the core iron oxide nanoparticles. Sustained release of the incorporated drug is observed over 2 weeks under in vitro conditions. The nanoparticles further demonstrated sustained intracellular drug retention relative to drug in solution and a dose-dependent antiproliferative effect in breast and prostate cancer cell lines. This nanoparticle formulation can be used as a universal drug carrier system for systemic administration of water-insoluble drugs while simultaneously allowing magnetic targeting and/or imaging.     

Enhanced antiproliferative activity of transferrin-conjugated paclitaxel-loaded nanoparticles is mediated via sustained intracellular drug retention

We studied the molecular mechanism of greater efficacy of paclitaxel-loaded nanoparticles (Tx-NPs) following conjugation to transferrin (Tf) ligand in breast cancer cell line. NPs were formulated using biodegradable polymer, poly(lactic-co-glycolide) (PLGA), with encapsulated Tx and conjugated to Tf ligand via an epoxy linker. Tf-conjugated NPs demonstrated greater and sustained antiproliferative activity of the drug in dose- and time-dependent studies compared to that with drug in solution or unconjugated NPs in MCF-7 and MCF-7/Adr cells. The mechanism of greater antiproliferative activity of the drug with conjugated NPs was determined to be due to their greater cellular uptake and reduced exocytosis compared to that of unconjugated NPs, thus leading to higher and sustained intracellular drug levels. The increase in antiproliferative activity of the drug with incubation time in MCF-7/Adr cells with Tf-conjugated NPs suggests that the drug resistance can be overcome by sustaining intracellular drug retention. The intracellular disposition characteristics of Tf-conjugated NPs following their cellular uptake via Tf receptors could have been different from that of unconjugated NPs via nonspecific endocytic pathway, thus influencing the NP uptake, their intracellular retention, and hence the therapeutic efficacy of the encapsulated drug.     

Real Time-PCR HBV-DNA Analysis: Significance and First Experience in Armed Forces

Background

HBV DNA quantitation is used extensively world wide for the diagnosis and monitoring of treatment of Hepatitis B virus (HBV) infection. However, it has still to be popular in India. The aim of this study was to quantitate HBV – DNA by Real time – PCR method in Hepatitis B and in immuno-compromised patients, to compare the results with HBeAg detection and to monitor the response to therapy of chronic Hepatitis B patients to antivirals.

Methods

Ninety one serum samples of Hepatitis group of patients (all HBsAg positive), 41 samples from immuno-compromised patients (all HBsAg negative) and 49 patients of Chronic Hepatitis B group (all HBsAg positive) were the subjects of this first ever study in Armed Forces. Twenty serum samples from healthy volunteers and non-hepatitis B patients served as negative controls. The amplification detection was carried out in a Rotor-Gene 2000-sequence detector

Results

Amongst Hepatitis B group, 33% (30/91) of the samples were positive for HBV-DNA and 26% (24/91) of samples were positive for HBeAg. In the immuno-compromised group of patients 14.6% (6/11) of samples were positive for HIV-DNA and 9.7% (4/41) were positive for HBeAg. Of the Chronic Hepatitis B patients on treatment, all (100%) were positive by HBV-DNA, whereas 29/49 (59.2%) were positive by HBeAg before treatment. After treatment with antivirals, 06/49 (12.2%) were positive by both tests and 11/49 (22.5%) were positive only by HBV-DNA. 32/49 (65.3%) patients became negative serologically after therapy.

Conclusion

HBeAg status did not necessarily reflect HBV-DNA level in the serum, as 10/91 (11%) in the Hepatitis B group, 2/41 (4.9%) in the immuno compromised group and 20/49 (40.8%) patients in the Chronic Hepatitis B group were positive for HBV-DNA but negative for HBeAg. HBV-DNA was not found to be positive amongst any of the negative controls. Real time – PCR is a sensitive and reproducible assay for HBV-DNA quantitation and may be started in Armed Forces referral centers in the near future.Key Words: Real time – PCR, Chronic Hepatitis B, HBV – DNA, Antivirals