Combination Vaccines

Infections are still a leading cause of morbidity and mortality in children under five years of age, most of which can be prevented by vaccination. However, there are too many vaccines to be administered, increasing the cost of immunization and visits to the paediatrician. Combination vaccines can be an answer to these problems till the development of a single vaccine containing all the possible antigens. Researchers are aiming at development of an ideal vaccine, which can be given orally at birth, has negligible side effects, is heat stable and is affordable to all the parents.Key Words: Infections, Immunization, Combination vaccines     

‘Empty sella’ on routine MRI studies: An incidental finding or otherwise?

Background

Empty sella (ES) has been regarded as an incidental finding. Recently, there have been studies documenting association of ES with hormonal and non-hormonal abnormalities. To detect the prevalence of empty sella in routine MRI brain study and to find associations with other diseases.

Methods

A retrospective study was carried out for patients undergoing MRI brain studies in the radiology department of a teaching institution. Patients with ES formed the study group. The rest formed the baseline population. Presence of nine select variables, viz. hormonal disturbances, headache, sensorineural hearing loss, seizures, vertigo, psychiatric disorders, visual disturbances, ataxia and raised intracranial tension, was analyzed amongst the study group, as well as the baseline population. Association of ES and the select variables was analyzed by determining means and proportions and using Chi-square test.

Results

During the study period, a total of 12,414 patients underwent MRI brain studies at our centre. ES was found in 241 (1.94%) patients. The proportion of patients in the ES and non-empty sella groups for each of the variables were as follows: hormonal disturbances (3.31% vs 0.56%, P = .000), headache (8.3% vs 7.4%, P = .596), SNHL (3.7% vs 1.3%, P = .0010), seizure (6.2% vs 13%, P = .002), vertigo (4.6% vs 1.6%, P = .000), psychiatric disorders (4.6% vs 1.3%, P = .000), visual disturbances (2% vs 1.1%, P = .166), ataxia (1.7% vs 1.2%, P = .519) and raised ICT (2% vs 0.5%, P = .002).

Conclusion

Hormonal disturbances, psychiatric disorders, raised ICT and SNHL have been found to be more often associated with ES as compared to general population.     

CAUSTIC SODA BURNS TO THE EXTREMITIES: DIFFICULTIES IN MANAGEMENT

SUMMARY Alkali burns to the extremities are unusual, but they are also a cause of significant morbidity, often because of their late presentation. Their management centres around water lavage, burn debridement and split-skin grafting; there is controversy over the timing of surgery. Three unusual cases of caustic soda burn in adults, and the difficulties encountered in their management, are described, and the literature is reviewed.     

Initial Experience with a New Technique of Binding Pancreaticogastrostomy: A Prospective Study

Aim

To study postoperative complications in patients undergoing binding pancreaticogastrostomy (PG) following pancreaticoduodenectomy (PD) in a tertiary hospital in India.

Methods

A prospective study was conducted of patients undergoing binding PG following PD over a 2-year period. The demographic and preoperative laboratory data of the patients, the type of procedure, complications, hospital mortality, duration of hospital stay, and postoperative interventional procedures or reoperations were recorded and examined for associations. Statistical analysis was performed using Stata 9.0 (College Station, Texas, USA).

Results

Over 2 years, 47 patients, 29 men and 18 women, mean age 55.4 ± 11.6 years, who underwent binding PG following PD were included in the study. Postoperative complications were recorded in 23 patients and there were 2 deaths in the first 30 days following surgery. The most frequent complication was delayed gastric emptying (DGE), observed in 11 patients (23%), with a mean duration of 13.5 ± 2.6 days. Post-operative pancreatic leak, which was detected in 3 patients (6%), did not appear to be influenced by the pancreatic duct diameter or the softness of the pancreas, which are known independent factors responsible for pancreatic leak.

Conclusion

The technique of binding PG is simple, safe, easy to perform, and less traumatic to the pancreatic stump, with fewer complications, and it can be performed without significant adverse outcome, irrespective of pancreatic stump texture or pancreatic duct diameter.

     

Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India

Background

Literature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV)-infected patients from developing countries is sparse. The objective of this study was to document the spectrum and determine the frequency of various opportunistic infections (OIs) and non-infectious opportunistic diseases, in hospitalised HIV-infected patients from north India.

Methods

One hundred and thirty five consecutive, HIV-infected patients (age 34 ± 10 years, females 17%) admitted to a tertiary care hospital in north India, for the evaluation and management of an OI or HIV-related disorder between January 2000 and July 2003, were studied.

Results

Fever (71%) and weight loss (65%) were the commonest presenting symptoms. Heterosexual transmission was the commonest mode of HIV-acquisition. Tuberculosis (TB) was the commonest OI (71%) followed by candidiasis (39.3%), Pneumocystis jiroveci pneumonia (PCP) (7.4%), cryptococcal meningitis and cerebral toxoplasmosis (3.7% each). Most of the cases of TB were disseminated (64%). Apart from other well-recognised OIs, two patients had visceral leishmaniasis. Two cases of HIV-associated lymphoma were encountered. CD4+ cell counts were done in 109 patients. Majority of the patients (82.6%) had CD4+ counts <200 cells/μL. Fifty patients (46%) had CD4+ counts <50 cells/μL. Only 50 patients (37%) received antiretroviral therapy. Twenty one patients (16%) died during hospital stay. All but one deaths were due to TB (16 patients; 76%) and PCP (4 patients; 19%).

Conclusions

A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India. Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

     

Refined mapping of genomic rearrangements involving the short arm of chromosome 9 in acute lymphoblastic leukemias and other hematologic malignancies

Deletions of chromosomal band 9p21 have been detected in various tumor types as well as in more than 20% of acute lymphoblastic leukemia (ALL). These deletions frequently include the entire interferon (IFN) gene cluster as well as the methylthioadenosine phosphorylase (MTAP) gene. Recently, the CDKN2 gene (p16INK4A, MTS I, CDK41) was proposed as a candidate tumor-suppressor gene on 9p21 because it is frequently deleted in cell lines derived from multiple tumor types. To determine if CDKN2 or another closely related gene on 9p is the target of 9p deletions in ALL and other hematologic malignancies, we analyzed 20 primary patient samples (13 ALL, 2 acute myeloid leukemias [AML], and 5 non-Hodgkin's lymphomas [NHL]) with 9p rearrangements using Southern blot analysis, fluorescence in situ hybridization (FISH), and single- strand conformation polymorphism (SSCP) for alterations of CDKN2. Homozygous deletions of the CDKN2/CDKN2B (p15) region were detected in 10 cases (50%; 6 ALL, 2 AML, and 2 NHL). In 1 additional case, the intensity of the Southern blot band was significantly reduced, suggesting a CDKN2 deletion in a subpopulation of the malignant cells. No CDKN2 or CDKN2B rearrangements were seen. The IFN gene cluster was homozygously deleted in 2 of 15 (13%) analyzed cases, whereas the MTAP gene was deleted in 6 of 15 cases (40%). In addition, hemizygous deletions of the CDKN2 region were identified in 6 ALL cases using interphase FISH. No point mutation of the coding region of CDKN2 was detected by SSCP in these cases. We conclude that CDKN2 is the most frequently homozygously deleted marker on 9p. The absence of point mutations in the coding region of CDKN2 in cases with hemizygous 9p deletions and the frequent codeletion of MTAP, CDKN2B, and other yet unidentified neighboring genes suggest that the simultaneous deletion of these genes may be necessary for the selective growth advantage of malignant cells.     

Enzymatic conjugation of erythrocyte glutathione with 1-chloro-2,4- dinitrobenzene: the fate of glutathione conjugate in erythrocytes and the effect of glutathione depletion on hemoglobin

Erythrocyte glutathione (GSH) can be rapidly depleted by incubating the cells with 1-chloro-2,4-dinitrobenzene (CDNB), which forms 2,4- dinitrophenyl-S-glutathione with GSH through the reaction catalyzed by glutathione S-transferase. GSH-CDNB conjugate thus formed stays undegraded within the erythrocytes. This indicates that in the erythrocytes, mercapturic acid pathway is inoperative. Depletion of GSH in the intact erythrocytes by CDNB results in rapid oxidation of large amounts of hemoglobin to methemoglobin. When glutathione S-transferase- free hemolysate of erythrocytes is incubated with CDNB, the depletion of GSH as well as methemoglobin formation are minimal. Glutathione peroxidase and glutathione reductase activities of the erythrocytes are not affected by CDNB. These studies provide a specific enzymatic method for rapid removal of erythrocyte GSH and also indicate that GSH is vital in maintaining a reduced environment within the erythrocytes.     

A study of empyema thoracis and role of intrapleural streptokinase in its management

Background  

Clinical spectrum, microbiology and outcome of empyema thoracis are changing. Intrapleural instillation of fibrinolytic agents is being increasingly used for management of empyema thoracis. The present study was carried out to describe the clinical profile and outcome of patients with empyema thoracis including those with chronic empyema and to study the efficacy and safety of intrapleural streptokinase in its management.