Cold Agglutinin Induced Hemolysis in a Newly Diagnosed Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a well-known autoimmune chronic inflammatory disease, which can virtually affect any organ system in the body. Although hemolytic anemia has been known to occur in < 10% of SLE patients, they are usually mediated through warm antibodies. It is extremely rare to see cold antibody-mediated hemolytic anemia in SLE, and only few cases have been reported in literature to our knowledge. This is a unique case report of SLE associated with cold agglutinin hemolytic anemia in a patient presented with generalized tender lymphadenopathy and typical B-symptoms including fever, night sweats, and significant weight loss.     

Management protocols of Allergic Fungal Sinusitis

Controversy surrounds the appropriate surgical approach and the appropriate medical therapy for Allergic Fungal Sinusitis. The present prospective study aims to assess the impact of these factors on the treatment outcome of Allergic Fungal Sinusitis. In the present study 34 cases with AFS were randomized into one of 3 methods of post operative therapy i.e. systemic itraconazole (group A, n=11), topical steroids (group B, n=12) and nasal alkaline douches only (group C, n=11). Outcome was assessed at 6 months post-operative by the Kupferberg grading system for assessment of nasal and sinus mucosa. Grade ‘3’ mucosal disease was defined as recurrence. Complete pre-operative opacification of sphenoid and frontal sinus was a predictor of poorer outcome. Postoperative systemic itraconazole therapy demonstrated a trend towards a better outcome but was not statistically significant. Larger trials are required to conclusively evaluate the merit of various post-operative treatment regimens for AFS.     

Autologous embedded foreign body of mobile tongue

Foreign bodies of upper aerodigestive tract are common otorhinolarygological emergencies. The foreign bodies of mobile tongue are however very rare and there are only limited case reports in literature. The case of a young female with an autologous foreign body mobile tongue with unusual presentation is presented.     

In vitro induction of cytotoxicity and DNA strand breaks in CHO cells exposed to cypermethrin, pendimethalin and dichlorvos

The indiscriminate use of pesticides and herbicides to increase crop productivity has aroused a great concern among the environmental and health scientists due to their adverse effects in both target as well as non-target species. Although substantial information is available regarding their environmental and ecological impact, not much is known in regard to its toxicity in the mammalian system. Therefore a study was conducted for the assessment of cytotoxic and genotoxic effects of cypermethrin (Type II pyrethroid) dichlorvos (organophosphate) and pendimethalin (dinitroaniline herbicide) in Chinese hamster ovary (CHO) cells. CHO cells were exposed to 1 μM, 10 μM, 100 μM, 1000 μM, and 10,000 μM, cypermethrin, pendimethalin and dichlorvos for 3 h and cytotoxicity was assessed by MTT assay. Their genotoxic potential was also evaluated by Comet assay. The results demonstrate that dichlorvos and pendimethalin exhibited higher extent of cytotoxicity as compared to cypermethrin. A significant (p < 0.05) concentration dependent increase in DNA damage was observed with dichlorvos (0.01 μM and above) and pendimethalin (0.1 μM and above) as evident by Comet assay parameters viz., Olive tail moment (arbitrary units), tail DNA (%) and tail length (μM). Cypermethrin induced a significant (p < 0.05) DNA damage only at higher concentrations (1000 and 5000 μM). Our data indicates that these chemicals produce cytotoxicity and DNA damage in mammalian cells and should be used with caution.     

Results of radiotherapy with, or without, salvage surgery versus combined surgery and radiotherapy in advanced carcinoma of the hypopharynx

There is considerable controversy surrounding the optimum treatment of advanced hypopharyngeal cancers. Curative radiotherapy with surgical salvage in reserve is an accepted protocol as is also a combined treatment of surgery and radiotherapy. The present study is a retrospective analysis of the survival results of 195 cases treated in a single centre. The combined surgery and radiotherapy group comprised a greater number of pyriform fossa and post-cricoid tumours whereas, the curative radiotherapy group had a higher proportion of posterior pharyngeal wall tumours. Actuarial two-year disease-free survival rates were significantly better with combined treatment when results of stage III and IV lesions (164 patients) of all sites are taken together, as compared to those obtained with curative radiotherapy without salvage (p = 0.000) or radiotherapy with surgical salvage for residual/recurrent tumours (p = 0.0021).     

Arsenic trioxide in the treatment of newly diagnosed acute promyelocytic leukemia: a single center experience

Arsenic trioxide (As(2)O(3)) has been found effective in the treatment in the treatment of acute promyelocytic leukemia (APML). Most studies with As(2)O(3) involve patients with APML who have relapsed following standard therapy. Between January 1998 and July 2000, 14 patients were recruited for an ongoing trial of As(2)O(3) in the treatment of newly diagnosed APML. Arsenic trioxide was administered at a dose of 10 mg/day until complete remission (CR) was achieved. Afterward, a consolidation course and a maintenance schedule consisting of As(2)O(3) as a single agent were administered over 6 months. There were 3 early deaths related to intra-cerebral hemorrhage: two on day 3 and one on day 4. Of the 11 evaluable patients, one died on day 21 secondary to uncontrolled sepsis, while the remaining 10 (91%) have attained CR. The average time to CR was 52.3 days (range: 34-70 days). One patient developed an isolated central nervous system (CNS) relapse and subsequently went into a second CR following therapy with triple intrathecal chemotherapy, cranial irradiation, and an additional 4-week course of systemic As(2)O(3). This patient, as well as the remaining nine, has continued to remain in CR at a median follow up of 15 months (range: 2-33 months). Eight out of 10 patients achieved molecular remission at variable periods during their consolidation and maintenance schedules. One patient developed an ATRA syndrome and was administered daunorubicin (40 mg/day) for 2 days. The side effects with this therapy were minimal and did not require cessation of therapy in any patient. There was no significant hepatic toxicity. In our experience, arsenic trioxide is effective in inducing and maintaining remission in patients with APML with minimal side effects. The optimal regimen and total dose required need to be defined.     

Blood pressure-independent attenuation of cardiac hypertrophy by AT(1)R-AS gene therapy

Our studies have established that a single intracardiac administration of the retroviral vector containing angiotensin II type I receptor antisense gene causes prolonged antihypertensive actions in the spontaneously hypertensive rat. These results suggest that antisense gene therapy is a conceptually valid strategy for the control of hypertension at the genetic level. To evaluate whether attenuation of the pathophysiological aspects of hypertension are dependent on the blood pressure lowering actions of antisense gene therapy, we chose the renin transgenic rat as a hypertensive animal model and cardiac hypertrophy as the hypertension-associated pathophysiology. A single intracardiac administration of the retroviral vector containing angiotensin II type I receptor antisense in the neonatal rat resulted in long-term expression of the antisense transgene in various cardiovascular-relevant tissues, including the heart. This expression was associated with a significant attenuation of cardiac hypertrophy despite its failure to normalize high blood pressure. Developmental studies indicated that cardiac hypertrophy was evident as early as 16 days of age in viral vector-treated control transgenic rats, despite these animals exhibiting normal blood pressure. These observations demonstrate that, in the renin-transgenic rat, the onset of cardiac hypertrophy occurs during development and is prevented without normalization of high blood pressure. Collectively, these results provide further proof of the concept and indicate that antisense gene therapy could successfully target the local tissues' renin-angiotensin system to produce beneficial cardiovascular outcomes.